What time does the nighttime protocol for sliding scale go into effect?!


Question: Help! I'm in nursing school, taking on-line classes, and cannot find ANYWHERE at what time the nighttime protocols go into effect for sliding scale insulin. I am trying to answer an assignment question that asks what my intervention would be for a FS prior to supper of 225. I don't know if I should use the daytime sliding scale or the nighttime sliding scale. Also (another question I can't find the answer to), if the FS @ 1700 is 200, using the moderate sliding scale for regular insulin with 20 units of NPH ordered for AM & 14 units of NPH ordered for PM, would that alter the PM dose of 14 units of NPH? I hate to ask for the answer, but my on-line class does not offer much in the way of support by teachers. I prefer to figure answers out on my own, but this one has me stumped. I would appreciate an explanation, not just an answer, as I am really trying to learn here.

Thanks!

Frustrated nursing student.


Answers: Help! I'm in nursing school, taking on-line classes, and cannot find ANYWHERE at what time the nighttime protocols go into effect for sliding scale insulin. I am trying to answer an assignment question that asks what my intervention would be for a FS prior to supper of 225. I don't know if I should use the daytime sliding scale or the nighttime sliding scale. Also (another question I can't find the answer to), if the FS @ 1700 is 200, using the moderate sliding scale for regular insulin with 20 units of NPH ordered for AM & 14 units of NPH ordered for PM, would that alter the PM dose of 14 units of NPH? I hate to ask for the answer, but my on-line class does not offer much in the way of support by teachers. I prefer to figure answers out on my own, but this one has me stumped. I would appreciate an explanation, not just an answer, as I am really trying to learn here.

Thanks!

Frustrated nursing student.

1) Daytime sliding scale-because the patient is going to eat. The nighttime scale is for when your patient is sleeping and therefore not going to eat. You need to keep in mind the reason WHY you are giving insulin. It is to facillitate the usage of insulin into the cells.
2) No, it would not affect the pm dosage ordered and you would give it as ordered. NPH insulin is what is called intermediate acting insulin. The onset of such insulin is 2-3 hrs. The peak is 8-12 hrs and the termination is 18-24 hrs. So lets assume that your pt has had a fingerstick that morning at approx. 5am. Lets assume that the fingerstick was as expected and the pt was covered under the sliding scale with regular insulin and then give the 20 units of NPH as scheduled. Now, it is 12 hours later and you are the nurse. You get the fingerstick at 1700 and it is 200. At this time the NPH insulin FROM 5 am would still be working to influence the pt's blood sugar.You would give regular insulin (short acting) at that time to cover the pt's blood sugar at that time. You would then give NPH as scheduled, usually at bedtime because that insulin acts over a longer period of time, ie until 5am when the morning fingerstick is due.
NOW if at 1700, you got a BS of 60, you would assume that the pt is getting too much NPH in the morning and bring that to the doc's attention. If the pt blood sugar was say 35 in the morning, you would want to consult the doc and consider reducing the nightime NPH dose or possibly holding it. Does this help? When doing insulin questions, always say to yourself, what is this insulin designed to do and why am I giving it to the patient. Isn't nursing school fun? For additional help, check out "Allnurses.com". email me if you get stuck again.

DAY time? NIGHT time? what ARE you talking about?
====
my scale is for 24/7/365. there is NO difference from day OR night.

my scale is as follows;
regular insulin IF, the reading is above 151.
then I use 9 units regular PLUS ''
151 - 200 = 2 units nph insulin
201 - 250 = 4 units
251 - 300 = 6 units
301 - 350 = 8 units
351 - 400 = 10 units
400 or over = 14 units and call the doctor immediately.

my nph insulin is 31 units all the time if I am reading under 151.
and usually I am always under 151. I seldom ever use regular insulin....
and by the way?? my doctor says to throw out the insulin inside 30 days...so my date is feb 15, 2008 to open the next bottles.

does this help?





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