(30251) Insulin SQ Prandial Carbohydrate
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1 Diagnosis Patient MUST BE educated using carbohydrate counting for prial insulin coverage before hospitalization to be eligible for this order set Nursing Metered Glucose (Single Select Section) Metered Glucose QID AC & HS Metered Glucose QID AC & HS & 2 a.m. Metered Glucose if Patient is NPO, on TPN, or Continuous Feeding Laboratory Serum Glucose Hemoglobin A1C QID, AC & HS, PRN if patient symptomatic. Notify if glucose greater than 250 mg/dl for 2 consecutive values. QID, AC & HS & 2 AM, PRN if patient symptomatic. Notify if glucose greater than 250 mg/dl for 2 consecutive values. Q6H PRN if symptomatic. Notify if glucose greater than 250 mg/dl for 2 consecutive values. If on insulin NovoLOG, change metered glucose to Q4H. PRN, ASAP. If metered glucose greater than 500 until glucose less than 500. Nurse to release order. One Time, Today. Medications Hypoglycemia Protocol hypoglycemia protocol See facility specific protocol. Insulin BASAL Basal insulin NPH (NovoLIN N) insulin NPH (NovoLIN N) breakfast BEFORE BREAKFAST, Subcutaneous. Dose: [ ] units. insulin NPH (NovoLIN N) lunch BEFORE LUNCH, Subcutaneous. Dose: [ ] units. insulin NPH (NovoLIN N) dinner BEFORE DINNER, Subcutaneous. Dose: [ ] units. insulin NPH (NovoLIN N) bedtime BEFORE BEDTIME, Subcutaneous. Dose: [ ] units. Basal insulin glargine (LANTUS) insulin glargine (LANTUS) bedtime BEFORE BEDTIME, Subcutaneous. Dose: [ ] units. Provider Initials Page 1 of 8
2 Basal insulin detemir (LEVEMIR) insulin detemir (LEVEMIR) bedtime BEFORE BEDTIME, Subcutaneous. Dose: [ ] units. Insulin PRANDIAL Prial insulin aspart (NovoLOG) insulin aspart (NovoLOG) breakfast insulin aspart (NovoLOG) lunch insulin aspart (NovoLOG) dinner Prial insulin regular (NovoLIN R) insulin regular (NovoLIN R) breakfast insulin regular (NovoLIN R) lunch insulin regular (NovoLIN R) dinner BEFORE BREAKFAST, Subcutaneous. Give immediately prior to a meal BEFORE LUNCH, Subcutaneous. Give immediately prior to a meal BEFORE DINNER, Subcutaneous. Give immediately prior to a meal BEFORE BREAKFAST, Subcutaneous. Give immediately prior to a meal. BEFORE LUNCH, Subcutaneous. Give immediately prior to a meal. BEFORE DINNER, Subcutaneous. Give immediately prior to a meal. Provider Initials Page 2 of 8
3 Insulin CORRECTIVE DOSE The type of insulin must match the type used for prial doses Insulin Corrective dose PREMEAL or if patient is NPO, on TPN, or Continuous Feeding insulin aspart (NovoLOG) on oral feedings TID AC, Subcutaneous. For patients who are tolerating oral feedings. Continue to administer corrective dose insulin for NPO patients. CORRECTIVE DOSES: Low Dose: Consider for patients requiring less than or equal to 40 units of insulin/day Medium Dose: Consider for patients requiring units of insulin/day High Dose: Consider for patients requiring more than 80 units of insulin/day. Blood glucose mg/dl (check desired scale) Individualized Low Medium High <70 Refer to Hypoglycemia Treatment Protocol pre-printed order set No corrective insulin, administer full dose of prial insulin, if ordered [ ] units [ ]units 1 units 2 units 3 units [ ]units 2 units 3 units 4 units [ ] units 3 units 5 units 7 units [ ]units 4 units 7 units 10 units 5 units 10 units 14 units Note: Do not administer corrective dose for PRN, post-prial or nocturnal glucose meter checks unless otherwise ordered. Note: The type of insulin used for corrective doses must match the type used for prial doses. Provider Initials Page 3 of 8
4 insulin aspart (NovoLOG) NPO Q4H, Subcutaneous. For patients who are NPO, on TPN, or Continuous Feeding CORRECTIVE DOSES: Low Dose: Consider for patients requiring less than or equal to 40 units of insulin/day Medium Dose: Consider for patients requiring units of insulin/day High Dose: Consider for patients requiring more than 80 units of insulin/day. Blood glucose mg/dl (check desired scale) Individualized Low Medium High <70 Refer to Hypoglycemia Treatment Protocol pre-printed order set No corrective insulin, administer full dose of prial insulin, if ordered [ ] units [ ] units 1 units 2 units 3 units [ ] units 2 units 3 units 4 units [ ] units 3 units 5 units 7 units [ ]units 4 units 7 units 10 units 5 units 10 units 14 units Note: Do not administer corrective dose for PRN, post-prial or nocturnal glucose meter checks unless otherwise ordered. Note: The type of insulin used for corrective doses must match the type used for prial doses. Provider Initials Page 4 of 8
5 insulin regular (NovoLIN R) on oral feedings TID AC, Subcutaneous. For patients who are tolerating oral feedings. Continue to administer corrective dose insulin for NPO patients. CORRECTIVE DOSES: Low Dose: Consider for patients requiring less than or equal to 40 units of insulin/day Medium Dose: Consider for patients requiring units of insulin/day High Dose: Consider for patients requiring more than 80 units of insulin/day. Blood glucose mg/dl (check desired scale) Individualized Low Medium High <70 Refer to Hypoglycemia Treatment Protocol pre-printed order set No corrective insulin, administer full dose of prial insulin, if ordered [ ] units [ ] units 1 units 2 units 3 units [ ]units 2 units 3 units 4 units [ ] units 3 units 5 units 7 units [ ] units 4 units 7 units 10 units 5 units 10 units 14 units Note: Do not administer corrective dose for PRN, post-prial or nocturnal glucose meter checks unless otherwise ordered. Note: The type of insulin used for corrective doses must match the type used for prial doses. Provider Initials Page 5 of 8
6 insulin regular (NovoLIN R) NPO Q6H, Subcutaneous. For patients who are NPO, on TPN, or Continuous Feeding CORRECTIVE DOSES: Low Dose: Consider for patients requiring less than or equal to 40 units of insulin/day Medium Dose: Consider for patients requiring units of insulin/day High Dose: Consider for patients requiring more than 80 units of insulin/day. Blood glucose mg/dl (check desired scale) Individualized Low Medium High <70 Refer to Hypoglycemia Treatment Protocol pre-printed order set No corrective insulin, administer full dose of prial insulin, if ordered [ ] units [ ] units 1 units 2 units 3 units [ ]units 2 units 3 units 4 units [ ] units 3 units 5 units 7 units [ ] units 4 units 7 units 10 units 5 units 10 units 14 units Note: Do not administer corrective dose for PRN, post-prial or nocturnal glucose meter checks unless otherwise ordered. Note: The type of insulin used for corrective doses must match the type used for prial doses. Provider Initials Page 6 of 8
7 Insulin Corrective Dose BEDTIME or BEDTIME AND NOCTURNAL (Consider Using Half of Pre-Meal Corrective Dose) insulin aspart (NovoLOG) BEDTIME, Subcutaneous If additional 2:00 AM nocturnal dose is desire, check the box for BEDTIME NOCTURNAL. BEDTIME NOCTURNAL at 2:00 am. insulin regular (NovoLIN R) Blood Glucose Add l Insulin < 70 See hypoglycemia protocol No insulin [ ] units [ ] units [ ] units [ ] units [ ] units 350 [ ] units call Note: Do not administer corrective dose for PRN, postprial or nocturnal glucose meter checks unless otherwise ordered. Note: For bedtime dose, consider using half of premeal corrective dose. If additional 2:00 AM nocturnal dose is desired, change frequency to BEDTIME NOCTURNAL. The type of insulin used for corrective doses must match the type used for prial doses. BEDTIME, Subcutaneous If additional 2:00 AM nocturnal dose is desire, check the box for BEDTIME NOCTURNAL. BEDTIME NOCTURNAL at 2:00 am. Blood Glucose Add l Insulin < 70 See hypoglycemia protocol No insulin [ ] units [ ] units [ ] units [ ] units [ ] units 350 [ ] units call Note: Do not administer corrective dose for PRN, postprial or nocturnal glucose meter checks unless otherwise ordered. Note: For bedtime dose, consider using half of premeal Provider Initials Page 7 of 8
![insulin regular (NovoLIN R) Blood Glucose Add l Insulin < 70 See hypoglycemia protocol 70-119 No insulin 120-149 [ ] units 150-199 [ ] units 200-249 [ ] units 250-299 [ ] units 300-349 [ ] units 350](/docs-images/46/21511714/images/page_7.jpg "[ ] units call Note: Do not administer corrective dose for PRN, postprial or nocturnal glucose meter checks unless otherwise ordered.")
8 Additional Orders corrective dose. If additional 2:00 AM nocturnal dose is desired, change frequency to BEDTIME NOCTURNAL. The type of insulin used for corrective doses must match the type used for prial doses. Provider Signature Date Time Provider Initials Page 8 of 8
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