Recently I was visiting with a patient during a diabetes education consult. The patient was on glargine and lispro sliding scale insulin. As I explained about sliding scale insulin, he related that during a previous admission to the hospital, he was given a prescription to take home for glargine insulin BID and one for lispro insulin which was to be taken three times a day before meals and that on the label it said “BMI 25-30″. He said no one explained to him what the prescription meant and when he picked it up at an outside pharmacy, the pharmacist also did not explain it to him. At home, he took his glargine as directed, then decided before a meal to try 25 units of lispro….
He said that he didn’t have any ill effects, but didn’t take any more that day. On another day, he decided to take 30 units before a meal, again with no ill effects. But then he said he just quit taking the lispro, though did continue glargine.
Fortunately for the patient, he was “non-complaint” with what he thought was the correct dose of lispro.
The hospital system has an order set which included correction insulin using lispro, based on BMI. This patient was on lispro correction BMI 25-30 scale while in the hospital and the doctor converted that specific order into a prescription at discharge. Doctors should be aware that it is inappropriate to convert the sliding scale based on BMI directly to a home prescription and that, if they desire a sliding scale, they should specify units of insulin to correspond with BG levels.
This could have been a disaster for this patient had he been more compliant with what he believed to be orders from the doctor.
When providing information or a prescription to a patient, only prescribe in UNITS.
Rosalie Leman RN, CDE
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