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Suggest Dosage For NovoLog
Question: I am having a conflict with my nurse director. Im an "older" LPN x 40 yrs, with a pretty good handle on diabetes. A physicians order reads
Novolog 70/30 mix 90 units (NINETY) TID.
My personal belief is that there was an error in transcription from doctor to unit clerk.
I am being told to give the 90 units, but I feel this is grossly high.
Please shed some light on this.
ps... The client is 256 lbs age 50 Female
Novolog 70/30 mix 90 units (NINETY) TID.
My personal belief is that there was an error in transcription from doctor to unit clerk.
I am being told to give the 90 units, but I feel this is grossly high.
Please shed some light on this.
ps... The client is 256 lbs age 50 Female
Brief Answer:
Insulin
Detailed Answer:
insulin therapy is a complex subject typically best managed by endocrinologists experienced in the realm of diabetes. The answer I give you here should not serve to refute orders by another physician or his/ her team. So your general impression is correct that such a premixed insulin dosed three times daily is not the ideal way to manage diabetes, it has been employed by some physicians in some types of patients. Typically a Basal bolus regimen of a long acting insulin like glargine or detemir combined with a rapid acting insulin such as aspart or lispro or glulysine is superior. However insulin therapy is highly individualized and so whichever treatment protocol achieves target glucose control without hypoglycemia is acceptable.
Insulin
Detailed Answer:
insulin therapy is a complex subject typically best managed by endocrinologists experienced in the realm of diabetes. The answer I give you here should not serve to refute orders by another physician or his/ her team. So your general impression is correct that such a premixed insulin dosed three times daily is not the ideal way to manage diabetes, it has been employed by some physicians in some types of patients. Typically a Basal bolus regimen of a long acting insulin like glargine or detemir combined with a rapid acting insulin such as aspart or lispro or glulysine is superior. However insulin therapy is highly individualized and so whichever treatment protocol achieves target glucose control without hypoglycemia is acceptable.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thanks for your info. You state that my impression is correct, that a TID regimen of Novolog 70/30 mix is generally "not the ideal. . ."
But I'm actually concerned about what seems to me to be a grossly high dosage, that being NINETY units TID.
Thats 270 units/day... Iv'e never seen nor heard of more than 100 u/day. Thanks
But I'm actually concerned about what seems to me to be a grossly high dosage, that being NINETY units TID.
Thats 270 units/day... Iv'e never seen nor heard of more than 100 u/day. Thanks
Brief Answer:
Follow up
Detailed Answer:
Some obese patients with type 2 diabetes can be severely insulin resistant and consequently have very high daily insulin requirements. This is worsened by the stress of hospitalization / surgery / steroids / certain pressors. So if this is not a typo, it is possible. I have used even higher doses than these albeit in basal-bolus form.
Follow up
Detailed Answer:
Some obese patients with type 2 diabetes can be severely insulin resistant and consequently have very high daily insulin requirements. This is worsened by the stress of hospitalization / surgery / steroids / certain pressors. So if this is not a typo, it is possible. I have used even higher doses than these albeit in basal-bolus form.
Note: For further follow-up, discuss your blood glucose reports with our diabetologist. Click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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