~ Deepak Asudani, MD Baystate Medical Center Any one of these approaches will produce a safe, conservative initial dose, but experts warn that none of the strategies by itself is a slam dunk. But as hospitalists switch from sliding scale to basal and bolus dosing, how do they calculate a safe total daily dose to start with? Experts say that physicians can use any of three different strategies, depending on whether patients have been using insulin as either an outpatient or in the ICU. Evidence keeps mounting that high blood sugars lead to worse outcomes in hospitalized patients “and that sliding scale regimens produce both more hyperglycemia and hypoglycemia. You can use one of several methods to determine a safe, initial dose Published in the August 2007 issue of Today’s Hospitalist. Tips For Calculating A Total Daily Dose Of Insulin The rounding rules for injections/syringes are often forgotten by students, but they should not be too hard to memorize: **We round to the hundredths place when an injection is less than 1 mL, because the syringe we use is calibrated to the nearest hundredth of
As you can see, each syringe has a capacity (how much it can hold), precision (the unit that we can measure to), a short phrasedescribing when it is used, and what we round calculations to. These are the syringes we will see most often in this course. As a quick refresher, have a look at the table in this PDF. There are others (as well see later), that are calibrated to the nearestsingle mL, or singleunit(for insulin calculations). In summary: Some instruments like syringes are more precise than others That is, some syringes arelabeled/calibrated to the nearest hundredth of a mL, while others are only calibrated to the nearest tenth, or two tenths of a mL.
Once again, please follow along with your content guide. The video below will discuss how precision relates to parenteral calculations and syringes. Lets take this conversation to some health care contexts. Be sure to note the differences on your content guide. Watch this short video discussing what is meant by precision and how this differs from accuracy. More specifically, we will round to the place value that matches the precision of the instrument we are using. These rules are determine by the instrument one is using to administer the medication. It can seem as though the rules are arbitrary and made up to confuse students but there is a reason why we round certain calculations to certain place values. Many students struggle with remembering what to round to and why. One of the more challenging aspects for students in this course is related to rounding.
Module 7: Parenteral & Insulin Dosage Calculations | Daniel Ozimek
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