1-71. INSULIN "COVERAGE"
a. When a diabetic is hospitalized, the combination of illness, stress, and
change in routine may cause an insulin imbalance. Therefore, the patient will normally
have routine urine (or blood) testing for sugar and acetone. If sugar is "spilled" into the
urine, additional insulin ("insulin coverage") is given in addition to the patient's regular
b. This coverage is commonly ordered on a "sliding scale." That is, the
physician will order additional insulin in correlation with the amount of sugar present in
the urine. For example: no sugar = no insulin, 1+ sugar = 5 units regular insulin, 2+
sugar = 10 units regular insulin, 3+ = 15 units regular insulin, 4+ = 20 units regular
insulin. As you see, the additional coverage is increased as the amount of sugar in the
1-72. NURSING IMPLICATIONS FOR ADMINISTRATION OF INSULIN
a. Be certain to give the correct type of insulin.
b. Prepare the correct dosage. Have another nurse double-check the dose
before you administer the injection.
c. Use the correct syringe. Never use a regular syringe for insulin. Use a
syringe calibrated in "units."
d. Before drawing up the insulin, gently "roll" the bottle between your palms to
mix and warm the solution.
e. Eliminate all air bubbles from the syringe. One small air bubble may displace
2 or 3 units of insulin.
f. Cleanse the skin with alcohol and allow to dry. This helps avoid pitting of the
g. Give the injection subcutaneously. Rotate the injection site with each dose.
(Rotating the sites prevents tissue necrosis.) Refer to figure 1-9 for injection sites.
h. Always check to see whether the patient is and has been eating his normal
(1) Administration of the regular dosage of insulin when the patient's intake
of food has been decreased or withheld could cause the blood sugar level to drop too