The practice of slidingscale insulin management persists even though it has been called a relic from the past that should be left in the medical history books. Several studies have revealed evidence of poor glycemic control and deleterious effects in sliding scale insulin use. Mar 31, 2018 use this sliding scale as an example only adjust per patient weight and activity or disability delays insulin until hyperglycemia appears cover as units per glucose 50 mgdl over 150 mgdl renal failure insulin 50% renal excreted v. Can lantus be used as a sliding scale with my current insulin of. Veterinary practice guidelines 2018 aaha diabetes management guidelines for dogs and cats ellen behrend, vmd, phd, dacvim, amy holford, vmd, dacvimy, patty lathan, vmd, dacvim, renee rucinsky, dvm, dabvpy, rhonda schulman, dvm, dacvim abstract diabetes mellitus dm is a common disease en countered in canine and feline medicine. Historically, sliding scale regular insulin was the issue now rapid acting insulins are a concern. S liding scale regular insulin ssi in themanagementofpatientswithdiabetes was the standard practice as earlyas19341andwasalsousedinthe hyperglycemic emergency diabetic ketoacidosis 2. Errors and poor outcomes with sliding scale insulin dosing studies demonstrate, and experts agree, that there is little evidence for using only sliding scale insulin to control blood glucose.
Do not use sliding scale insulin for longterm diabetes management for individuals residing in the nursing home. Typically, the issue that arises is the level of supervision that is required when a registered nurse delegates activities. Adult sliding scale for insulin regular novolin r umc health. Sliding scale regular insulin dc oral antidiabetic drugs on admission starting total daily dose tdd.
Randomized study of basalbolus insulin therapy in the. Use of a standardized protocol to decrease medication. It may be stated as a stepwise correction or sliding scale or may need to be calculated by a formula to determine dose. Based on insulin sensitivity estimate sensitivity using rule of 1800 bg change per unit insulin. First described in 1934, what physicians typically refer to as sliding scale insulin ssi is fast or rapidacting insulin only, given subcutaneously, typically at meal times and sometimes bedtime, but only when blood glucose is above a threshold e. Continue to repeat 10 units subcut and poc blood until blood glucose is less than 300 mgdl, then resume normal poc blood sugar check and insulin regular sliding scale. Sliding scales are less effective in covering a premeal high blood sugar, because the high blood glucose correction and food bolus cannot be split. In most slidingscale insulin therapy regimens, your blood sugar is taken using a glucometer. Mixed insulin is more likely to cause hypoglycemia8,19 and generally requires a fixed meal schedule8. Bg change per unit insulin 1800total insulin daily. Lispro goal blood glucose is insulin regular or ra. Patients in a mixed medicalsurgical icu were compared during two 9 month periods. Goal blood glucose is insulin regular or ra bg 200249. You can take lots of diabetes medications by mouth.
Guide to starting and adjusting insulin for type 2 diabetes. And, in my opinion, it is a prime example of a diabetes treatment strategy that makes no sense but that many providers continue to employ without regard for common. Divide the total carbohydrates by the insulin to carbohydrate ratio. Slidingscale regular insulin ssi in the management of patients with di abetes was the standard. Insulin dosing using an insulin tocarb ratio and correction factor. Humalog sliding scale insulin coverage blood sugar result humalog insulin coverage subq 60 124 no coverage 125 150 2 units of humalog insulin subq 151 200 4 units of humalog insulin subq 201 250 6 units of humalog insulin subq 251 300 8 units of humalog insulin subq 301 350 10 units of humalog insulin subq. Slidingscale insulin diabetes care american diabetes association. Aug 06, 2018 sliding scale low dose novolog novolog mix 70 30 insulin aspart protamine and standard sliding scale insulin orders 0307 phary hospital management of home medications sliding scale for insulin aspart novolog. Once again, this will vary from student to student.
The agency for healthcare research and quality ahrq offers free clinician and consumer guides that compare the benefits and risks of medications andor other therapies for a wide range of health problems such as type 2 diabetes, gestational diabetes, osteoarthritis, osteoporosis, rheumatoid arthritis, depression, and rental artery stenosis. Sliding scale insulin regimens approximate daily insulin requirements. Some people have a different insulin tocarb ratio for breakfast than at other meals. When prescribing insulin, cross reference on the in patient prescription chart eg insulin as per chart. Sliding scale regular insulin ssi in the management of patients with diabetes was the standard practice as early as 1934 1 and was also used in the hyperglycemic emergency diabetic ketoacidosis 2.
Sliding scale insulin ssi is commonly used to manage hospitalized patients with and without diabetes mellitus. Give supplemental insulin lispro following the sliding scale protocol 1d for blood glucose 140 mgdl. National subcutaneous insulin charts australian commission. The document applies to adult patients in acute care inpatient settings. The results from reference 6 are in line with the relatively impaired insulin sensitivity and higher insulin concentrations reported in healthy adolescents 8, 9. A study comparing scheduled basal bolus insulin to sliding scale insulin only showed a significantly higher percentage of patients achieving goal glucose levels in the basalbolus group than in the sliding scale only group 66 vs.
Insulin dosing using an insulintocarb ratio and correction. You may need medicines in addition to healthy eating and exercise habits to handle your type 2 diabetes. Capitals indicate lifethreatening, underlines indicate most frequent. Administer 14 units subcut, notify provider, and repeat poc blood sugar check in 1 hour. Lantus insulin glargine, a longacting insulin is used for treating type 1 q.
Sliding scale insulin has been in use for more than 80 years without much evidence to support its use as the standard of care. Find out how it works and learn about problems with this diabetes. It is often given in addition to the usual dose that you take to cover your meal. This is done about four times a day every five to six hours, or before meals and at bedtime. Correction insulin corrects or lowers high blood sugars before meals. Sliding scale insulin refers to a treatment regimen that.
Insulin sliding scale, correctional insulin dosing. It guides the use of iv insulin infusions sometimes referred to as sliding scale insulin in diabetic and nondiabetic patients for the purposes of maintaining moderate euglycaemia. Adult sliding scale for insulin aspart novolog umc health system. Registered nurses can delegate a wide range of tasks, including sliding scale insulin.
Canadian agency for drugs and technologies in health 600865 carling avenue, ottawa, ontario, 1s 5s8. Nsw adult subcutaneous insulin prescribing chart user guide. This page includes the following topics and synonyms. A nomogram for intravenous insulin infusion in critically ill patients was evaluated in a retrospective beforeafter cohort study. You probably will find some beneficial info in this post, come have a glimpse. These earlier studies used urine glucose for sliding scale, but with. Taking insulin or other diabetes medications is often part of dealing with diabetes in addition to healthy food choices and exercise, medicine can assist you handle the disease. All insulin available in the united states is manufactured in a laboratory, but animal insulin can still be imported for personal use.
Continue to repeat 10 units subcut and poc blood sugar checks every 30 minutes until blood glucose is less than 300 mgdl, then resume normal poc blood sugar check and insulin aspart sliding scale. In most sliding scale insulin therapy regimens, your blood sugar is taken using a glucometer. Mar 31, 2018 sliding scale insulin has been in use for more than 80 years without much evidence to support its use as the standard of care. In most ssi treatment regimens, a patients blood sugar is measured using a. Clinical guideline for the use of intravenous sliding. Most people with type 2 diabetes start medical treatment with metformin. Sliding scale insulin therapy involves creating and following an individual chart. Type 2 diabetes adult outpatient insulin guidelines if postmeal glucose levels 180. Stepwise dosing and titration of insulin for type 2 diabetes. The commission has produced national subcutaneous insulin charts for acute and subacute hospitals and mental health facilities. Patients will receive the fulldose of glargine insulin even if npo except for those that have gfr insulin dose. Novolog 70 30 sliding scale chart best picture of chart. The sliding scale group was treated using ad hoc sliding scale infusion therapy.
Revised chapter 9insulin treatment in children and. Administer 12 units subcut, notify provider, and repeat poc blood sugar check in 30 minutes. Calculate insulin dose for food add up all the carbohydrates in your meal. It is difficult to 9obtain optimal control without occasional, mild episodes of hypoglycemia. Consider using a basalbolus and supplemental correction insulin regimen. Reduce the dose if npo hold if npo do not hold if npo subcutaneous insulin. These support the delivery of appropriate care and improve the management of blood glucose levels bgls in these different groups of patients. Optimizing glucose management in hospitalized patients. The patients treated with the basalboluscorrection supplemental program had lower blood glucose at all times of day and had of the major postoperative complications, compared to patients treated with correction insulin alone umpierrez, 2011. Jan 31, 2020 in sliding scale insulin therapy, the dose is based on your blood sugar level.
Harnett healths lillington medical services has two convenient locations to serve lillington are residents, one location is located at 716 s. Type 2 diabetes mellitus is a chronic, progressive disease characterized by multiple defects in glucose metabolism, the core of which is insulin resistance in muscle, liver, and adipocytes and. Optimizing glucose management in hospitalized patients using. Sliding scale insulin regimens for type 2 diabetes. Apr 05, 2019 sliding scale insulin therapy involves creating and following an individual chart. Scope the guideline covers all adult patients on dccq who require variable rate intravenous insulin infusion vriii.
And, in my opinion, it is a prime example of a diabetes treatment strategy that makes no sense but that many providers continue to employ. To use an insulin tocarb ratio, you need to count the carbohydrate at a meal. Sliding scale insulin ssi, a treatment regimen that has been around since the 1930s, is most often used in hospitals. If a patient on ssi developed hypoglycemia, the insulin scale was decreased from the insulin resistant to the usual column or from the usual to the insulin sensitive column. Correction insulin sliding scale, supplemental, bolus. Sliding scale regular or humalog insulin uw health. For sliding scale insulin, a resident who is stable may only require general supervision, whereas, a resident who is unstable getting. Some people also take it if blood sugars are high at bedtime. Can lantus be used as a sliding scale with my current insulin. The amount of insulin to correct a blood glucose level above the students target range.
These earlier studies used urine glucose for sliding scale, but with demonstration of inaccuracy of urine glucose 3, blood glucose replaced urine glucose for sliding scale. If patient unable to do multiple daily injections, consider switching to mixed insulin instead of adding prandial insulin. Our practice specializes in internal medicine, infectious disease, and gynecology. In sliding scale insulin therapy, the dose is based on your blood sugar level. Scheduled insulin correction insulin basal insulin. The sliding scale method does not accommodate changes in insulin needs related to snacks or to stress and activity. Stepwise dosing and titration of insulin for type 2. Insulin, given either intravenously or subcutaneously, is the preferred regimen for effectively treating hyperglycemia in the hospital. Aimpurpose of this guideline this guideline is for the management of for the management of adult patients with diabetes mellitus requiring intravenous sliding scale insulin infusion. Premixed regimens insulin regimens for type 2 diabetes using one daily injection of insulin insulin regimen with an insulin pump. These earlier studies used urine glucose for sliding scale, but with demonstration of inaccuracy of urine glucose 3, blood glucose replaced urine glucose for sliding scale in diabetic. Insulin dosing worksheet sliding scale insulin to carbohydrate ratio 1 unit. Jan 01, 2018 type 2 diabetes mellitus is a chronic, progressive disease characterized by multiple defects in glucose metabolism, the core of which is insulin resistance in muscle, liver, and adipocytes and.
907 1090 942 653 721 1299 1174 552 871 263 231 361 59 1289 654 599 1138 415 937 9 1493 1244 1307 1293 983 90 386 1122 785 957 114 1211 1365 824 1402 52 296 140