It may be stated as a stepwise correction or sliding scale or may need to be calculated by a formula to determine dose. Lantus insulin glargine, a longacting insulin is used for treating type 1 q. In sliding scale insulin therapy, the dose is based on your blood sugar level. Augmentation therapy with basal insulin may be initiated at 10 units once daily, or by using weightbased dose cal culations. The role of insulin in achieving optimal glycemic control in nonpregnant patients with type 2. General guidelines for the prescriber all insulin must be ordered in number of units to be given. 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. The basic premise of sliding scale insulin ssi is to correct hyperglycemia through the frequent administration of shortacting insulin dosed according to a patients blood glucose level with the help of a prespecified rubric.
Inpatient management of hyperglycemia and diabetes. A lot of people require insulin therapy to manage their blood sugar levels and keep. Randomized study of basalbolus insulin therapy in the. First step into insulin therapy how to start insulin in a patient not controlled on oads by dr. Sliding scale insulin for medical and nursing students. 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.
Administer 14 units subcut, notify provider, and repeat poc blood sugar check in 1 hour. An understanding of different insulin s, their action and safe dose adjustments. The term sliding scale refers to the progressive increase in premeal or nighttime insulin doses. Sliding scale insulin ssi is not an effective way of managing longterm. Also, there are many variations of insulin therapy. 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. The therapeutic options for such patients include adding a second or third oral agent or an injectable agent, such as a glucagonlike peptide1 glp1 receptor agonist or insulin, or switching to insulin. Many people with type 2 diabetes need insulin therapy. The general principles of sliding scale therapy are. Optimizing glucose management in hospitalized patients. Pdf sliding scale regular human insulin for identifying. At the end of the trial, there was no difference in glycemic control between the groups. 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.
Sliding scale insulin therapy involves creating and following an individual chart. As the nighttime scale only considers the amount of insulin required to drop your blood sugar level back into the target range, it should not be used to cover a bedtime snack. It should be emphasized that using a correction scale insulin regimen, also known as sliding scale insulin, alone is not appropriate to treat sustained hyperglycemia 140 mgdl. The term sliding scale refers to the progressive increase in the premeal or nighttime insulin dose, based on predefined blood glucose ranges. Insulin is usually injected in the fat under your skin using a syringe, insulin pen or insulin. The purpose of this report is to provide evidence on the clinical benefits and harms and costeffectiveness of basalbolus versus sliding scale insulin therapy for adult patients with type 1 or type 2 diabetes in the acute care hospital setting.
There are different types of insulin depending on how quickly they work, when they peak, and how long they last. Evaluating efficacy of sliding scale insulin therapy 10. The sweet success guidelines, revised in 2002 do not completely reflect this information since they were being revised just as the new therapies became available in pregnancy. The amount of insulin to correct a blood glucose level above the students target range. Sliding scale therapy approximates daily insulin requirements. The full text of this article is available in pdf format. Sliding scale regimens may include a bedtime high blood sugar correction. The higher your blood sugar after eating, the more extra units of insulin you will take called a bolus. Calculating insulin dose diabetes education online. Sliding scale insulin ssi, a treatment regimen that has been around since the 1930s, is most often used in hospitals. Managing hyperglycemia and diabetes in patients receiving. Insulin therapy started in 1922 using regular insulin before each main meal and one injection in the night, usually at 1 am. Administer 10 units subcut, notify provider, and repeat.
Find powerpoint presentations and slides using the power of, find free presentations research about sliding scale insulin therapy ppt. Sliding scale insulin therapy is one way a person with diabetes can work out how much insulin to take before a meal without causing negative effects on. 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. A total of insulin naive patients were randomized to receive glargine and glulisine n 65 or a standard ssi protocol n 65. The practice of sliding scale insulin management persists even though it has been called a relic from the past that should be left in the medical history books. Sliding scale insulin vs basalbolus insulin therapy in. Consider insulin as initial therapy if a1c very high, such as 10. Since the introduction of insulin analogs in 1996, insulin therapy. Insulin for gestational and pregestational diabetes there have been several changes in the management of diabetes during pregnancy, including the use of insulin analogs. 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.
In patients with type 2 diabetes mellitus, insulin may be used to augment therapy with oral glycemic medications or as insulin replacement therapy. 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. A sliding scale is a prefixed base amount of insulin with an extra boost of insulin as needed. Sliding scale insulin ssi therapy remains a common means of insulin therapy in longterm care ltc for the management of type 2 diabetes mellitus, despite current recommendations not supportive of the form of therapy today. Revised chapter 9insulin treatment in children and. Sliding scale insulin chart dosage sliding scale insulin therapy healthline in sliding scale insulin therapy the dose is based on your blood sugar level find out how it works and learn about problems with this diabetes treatment image result for sliding scale insulin chart dosage what is an insulin sliding scale chart an insulin sliding. Patients taking only bedtime nph insulin or only a basal insulin need. Insulin for gestational and pregestational diabetes. Please keep in mind, the estimated insulin regimen is an initial best guess and the dose may need to be modified to keep your blood sugar on target. Usually you will have the same long acting insulin dose every day, and a faster acting one to correct your high blood sugar levels that changes. Lantus sliding scale pdf in sliding scale insulin therapy, the dose is based on your blood sugar level. Find out how it works and learn about problems with this. Sliding scale insulin therapy xcale drugs can also cause you to have fewer symptoms of hypoglycemia, making it harder to tell when your blood sugar is low. Sliding scale regular human insulin for identifying critically ill patients who require intensive insulin therapy and for glycemic control in those with mild to.
Start insulin if a1c and glucose levels are above goal despite optimal use of other diabetes medications. Insulin is a protein hormone that is used as a medication to treat high blood glucose. When using a sliding scale, eat the same amount of carbohydrate at each meal. Consider initiating insulin replacement therapy when the blood glucose level is 300 to 350 mg per dl 16. Basal insulin is best starting insulin choice for most patients if fasting glucose above goal. Scheduled basalbolus insulin is designed to prevent hyperglycemia, whereas correction scale insulin only attempts to lower hyperglycemia after it has occurred. Basalbolus versus slidingscale insulin therapy in the. When blood glucose levels are low, patients receive little or no insulin, and when blood glucose levels are high. Find out how it works and learn about problems with this diabetes.
If hypoglycemia develops, consider reducing dose or discontinuing secretagogue. Highlight guidelines specific to initiating insulin therapy in type 1. Mashfiqul hasan phase b resident department of endocrinology bsmmu 2. Management of hyperglycemia in diabetic patients with.
Education on use of the equipment used in the procedure and its safe disposal 3. A lot of kitties actually do very well on fixed doses at fixed times. Do not use sliding scale insulin for longterm diabetes management for individuals residing in the nursing home. Can lantus be used as a sliding scale with my current insulin of. Diabetes mellitus, also known as sugar in layman language is a disease in which the bodys ability to produce or respond to the hormone insulin is impaired, resulting in abnormal metabolism of carbohydrates and elevated levels of glucose in the blood insulin therapy is the mainstay of treatment in type 1 diabetes mellitus. In this study, patients were randomized to sliding scale regular insulin ssri alone or in combination with glargine. Christa frodella please send us a youtube message for more details. Once again, this will vary from student to student. You will need to work out your specific insulin requirements and. Education in insulin therapy, including reasons for insulin treatment, contraindications, complications and appropriate aftercare 2. A retrospective analysis was conducted to determine whether a basal bolus insulin bbi regimen with detemir and aspart is superior to a sliding scale regular insulin ssi regimen for management of hyperglycemia in hospitalized diabetic patients receiving dexamethasone. Stepwise dosing and titration of insulin for type 2. Optimizing glucose management in hospitalized patients using a. Premixed, or shortacting insulin analogs or regular and nph, given twice a day.
This guideline is for intravenous sliding scale insulin, it is to be used in conjunction with the new 2 day intravenous sliding scale insulin prescription chart. This is done about four times a day every five to six hours, or before meals and at bedtime. If it is your hopeplan to use sliding scale dosage then you would be better opting for a nondepot insulin like prozinc or pzi these are more adaptable when it comes to changing the dose and the time of the shot. Stepwise dosing and titration of insulin for type 2 diabetes in the ambulatory setting update 52010. Research design and methods we conducted a prospective, multicenter, randomized trial to compare the efficacy and safety of a basalbolus insulin regimen with that of sliding scale regular insulin. The desired frequency of smbg testing for insulin dose adjustments is an important issue. The goal of insulin therapy is to keep your blood sugar levels within a target range. With the development of intermediate and longacting insulin, most patients moved to one or two injections per day after 1935. Insulin therapy in the outpatient setting american college of.
Adult sliding scale for insulin regular novolin r umc health. Insulin therapy is a critical part of treatment for people with type 1 diabetes and also for many with type 2 diabetes. Insulin pharmacology, therapeutic regimens, and principles of. Administer 12 units subcut, notify provider, and repeat poc blood sugar check in 30 minutes. All insulin available in the united states is manufactured in a laboratory, but animal insulin. In this video we talk about sliding scale insulin for medical students and nursing students. View and download powerpoint presentations on sliding scale insulin therapy ppt. Objective we sought to study the optimal management of hyperglycemia in nonintensive care unit patients with type 2 diabetes, as few studies thus far have focused on the subject. Guide to starting and adjusting insulin for type 2 diabetes cadth. Sliding scale regular insulin for the management of nonicu patients with type 2 diabetes sliding scale regular insulin dc oral antidiabetic drugs on admission starting total daily dose tdd. Basalbolus versus sliding scale insulin therapy in the. Adjust insulin dose every 3 days until bg sliding scale depending on sensitivity.
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