Hi, this is Cathy with Level Up RN. In this video, I will be going over a variety of insulin orders, including orders for correctional coverage, orders for fixed and correctional coverage, orders for nutritional coverage, and orders for nutritional and correctional coverage. You can find all the information that I'll be covering in this video in our Level Up RN dosage calculation workbook. If you are in nursing school, then you know how important it is to master dosage calculations, and our workbook will help you do just that. In a nutshell, our workbook contains all different types of dosage calculation problems that you are likely to encounter in nursing school. And we demonstrate how to solve each problem using multiple methods so you can pick the way that makes the most sense to you.
With correctional coverage, the amount of insulin that you will administer to your patient is dependent on their blood glucose level that you get through point-of-care testing. Unless otherwise noted, you should get your patient's blood glucose level prior to their meal. Then you would use this sliding scale here to determine the number of units of insulin to provide your patient based on their blood glucose level. So in our example here, prior to eating breakfast, our patient's blood glucose is 282. The patient has the following order for insulin: insulin lispro 100 units per ml, administered 2 to 12 units correctional coverage subcutaneous three times daily with meals, and use the sliding scale provided. And we need to determine how many units of insulin we need to administer our patient with their breakfast. Okay. So our patient's blood glucose level is 282. So I'm going to come over here to this first column and find the appropriate blood sugar range, which is right here. 282 falls within this range. So if I go over here to the right, I will see that my patient needs 6 units of insulin, and that is their correctional coverage. Some of your patients may have fixed end correctional coverage for their insulin. That means they get a set amount of insulin plus additional insulin based on their blood glucose and using the sliding scale, which I have here on the screen. So those two doses are combined into one syringe and administered to the patient.
So in this problem, we have prior to eating lunch, your patient's blood glucose is 240. The patient has the following order for insulin, insulin lispro, administer 3 units subcutaneous three times daily with meals, plus 2 to 12 units correctional coverage using the sliding scale. How much insulin should be administered with lunch? So if you look at this order, this 3 units here, that is the fixed coverage that the patient is going to get, so they're getting those 3 units. And then we need to figure out how much they need in terms of correctional coverage based on their blood glucose level. So for 240, if we go and look at the sliding scale here, we will find that 240 falls within this range here on the third row. And if we go over to the right here, we see that we will need to administer 4 units of insulin for that blood sugar value. So we would take the 3 units fixed amount that the patient needs to get, add in the 4 units of correctional coverage, and that will give us 7 units total that we need to administer to our patient.
With nutritional coverage, the amount of insulin that your patient will receive is dependent on how many carbs they consumed with their meal and the prescribed insulin-to-carbohydrate ratio. So here in this table, all of these food items are approximately equal to 15 grams of carbohydrates. Salad greens are considered a free food because they have so few carbs. So one slice of bread has approximately 15 grams of carbs. One cup of milk, again, approximately 15 grams of carbs. And that is the same for all of these items. So in our example here at the bottom, we have an order to administer one unit of insulin for every 10 grams of carbohydrates consumed with each meal. And our patient consumed spinach and artichoke ravioli, which is 45 grams of carbohydrates, one slice of bread, a half a cup of peas, and one cup of milk. And we need to determine how many grams of carbohydrates did our patient consume with this meal, and how many units of insulin will we need to administer. So let's take a look at their meal. We already know that they got 45 grams from the ravioli. Let's look up their slice of bread. So here we can see that one slice of bread equals 15 grams of carbohydrates, so now we're up to 60 grams. And they also had a half a cup of peas, which is also another 15, so that's 75 grams of carbs. And then they had one cup of milk, which is another 15. So they had a total of 90 grams of carbohydrates with their meal. So for a 1:10 ratio, we would need to give our patient 9 units of insulin to cover the 90 grams of carbohydrates that they consumed with this meal.
If your patient has nutritional and correctional coverage for their insulin, then the amount of insulin they'll receive is dependent on their blood glucose level before eating and using the sliding scale. And they will get additional insulin based on how many carbs they consumed with their meal using the prescribed insulin to carbohydrate ratio given to you by the provider. Okay. So for this example, before dinner, our patient's blood glucose is 186. Our patient consumes 60 grams of carbohydrates with dinner. The patient has the following order: insulin lispro, 100 units per ml, administered 2 to 12 units subcutaneous, sliding scale coverage, plus nutritional coverage with an insulin-to-carbohydrate ratio of 1 to 10. How much insulin should be administered with dinner? Okay. So let's first figure out how much insulin our patient will require in terms of correctional coverage. So their blood glucose level before dinner was 186. So if we go up here to the sliding scale and find the applicable blood sugar range, it is here in the second row. And if we go over here, we see that they're going to need 2 units of insulin in terms of correctional coverage. However, they also have nutritional coverage. So with dinner, they consumed 60 grams of carbohydrates. So since we have a 1 unit of insulin equals 10 carbs ratio, this means that they will need 6 units of insulin for their nutritional coverage. So if we add 2 units of correctional coverage to the 6 units of nutritional coverage, our patient will need 8 units total of insulin with their dinner.
