Hendricks Regional Health U-500 Insulin Orders printable pdf download

Hendricks Regional Health U-500 Insulin Orders

U-500 INSULIN ORDERS

Form #9230p1

Rev. 09/11

Page 1 of 2

1. Initial Orders:

Discontinue all prior subcutaneous insulin orders when initiated

Hemoglobin A

C if NOT performed already during this admission

Endocrinology consult

Consult diabetes nurse educator for education

2. Blood Glucose Schedule:

AC and every hs

AC, every hs, and 0300

Other, please specify_________________________________

3. U-500 Insulin Orders:

Give HUMULIN® R U-500 INSULIN subcutaneous per order below:

Before breakfast:

_____units = _____ ml markings on a 1ml TB syringe

Before lunch:

_____units = _____ ml markings on a 1ml TB syringe

Before supper:

_____units = _____ ml markings on a 1ml TB syringe

Other:

units=

ml markings on a 1 ml TB syringe

4. Call Orders:

Call if BBG or glucose level less than 80 or greater than 400.

Call if diet orders change to NPO or the patient is consuming less than 50% of ordered

meal for a possible dose reduction

Other _______________________________________________________________

Prescriber Signature

Date

Time

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Hendricks Regional Health U-500 Insulin Orders