The patient is not diabetic but he is getting regular insulin as a sliding scale. What do you tell the patient? If you have already ascertained this is not an error and you understand why they are receiving it you can tell the patient the rationale. Common reasons for non-diabetics to have elevated blood sugar is TPN (Mr. Jones while you are unable to eat you are receiving a high concentration of sugar in your IV and you need extra insulin.) and high dose steroids (Mr. Jones you are receiving solumedrol, a steroid medication, to reduce inflammation in your lungs caused by the pneumonia. That medication increases blood sugar requiring extra insulin) Also inform patients this is a short term situation and likely will not continue once they are off those medications.

What does 70/30 mean? 75/25?

Always read the label. A ratio on the label indicates premixed insulin. 70/30 means that 70% of the insulin is NPH and 30% is Regular. Therefore if you have 10 units to give your patient, 7 units would be NPH and 3 units would be Regular. There is 75/25 insulin which is 75% NPH with 25 % Lispro.

The patient is NPO -should you give the insulin?

First, ask why are they NPO? If they are NPO, but receive tube feedings or TPN, they will still get the insulin. If they are NPO for surgery, you may have to hold or give a smaller dose if ordered. Be sure to communicate with the OR if any insulin was given. In any case, be sure to check with the nurse before giving any insulin in these situations.

The patient is going for dialysis. Are you going to give the insulin?

Check with the dialysis nurse. While patients can eat while on dialysis it depends on the institution because some dialysis units do not allow food. If you do give the insulin but be sure to take or send their meal tray to the dialysis unit.

In what order do you mix insulins?
Having to mix insulins in front of your nursing instructor at 7:30 in the morning can be intimidating. Here's an easy way to remember the order depending on if you are in a RN or LPN program: Remember your goal: I want to be an RN (Regular then NPH) or I want to be an LPN (Last Put NPH)

In regards to mixing insulins you are limited to Regular and NPH. Do not mix others even if it means the patient is going to have 2 injections.