During the morning rounds, Nurse AJ accompanied the physician in every patient’s room. The physician writes orders for the client with diabetes mellitus. Which order would the nurse validate with the physician?
A. Use Humalog insulin for sliding scale coverage.
B. Metformin (Glucophage) 1000 mg per day in divided doses.
C. Administer regular insulin 30 minutes prior to meals.
D. Lantus insulin 20U BID.
Correct Answer: D. Lantus insulin 20U BID.
Lantus insulin is usually prescribed once a day so an order for BID dosing should be validated with the physician. Lantus is designed to give a steady level of insulin over 24 hours, even when you are not eating such as between meals and overnight. This helps keep blood glucose levels consistent during the day and at night.
Option A: Humalog insulin can be prescribed for sliding scale coverage. The use of Humalog includes correcting the high blood sugar levels just before mealtime. For this aspect, a sliding scale is used to identify the needed amount of insulin that the patients must take.
Option B: Metformin (Glucophage) is often prescribed in divided doses of 1000 mg per day. Metformin is an oral medication typically dosed from 500 to 2550 mg per day and administered with a meal to decrease GI upset. The daily dose is often titrated weekly in increments of 500 mg or 850 mg to reduce this risk.
Option C: Regular insulin is administered 30 minutes before meals. Insulin, regular when administered subcutaneously, should be injected 30 to 40 minutes before each meal. Avoid cold injections. The injection is in the buttocks, thighs, arms, or abdomen; it is necessary to rotate injection sites to avoid lipodystrophy.
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