Sliding scale insulin use myth or insanity pdf

In those patients whose blood glucose remained greater than 180 mgdl, we used a twice daily regimen of intermediate acting insulin together with insulin amounts on a sliding scale to keep the blood glucose less than 180 mgdl. Its time to abandon the sliding scale mdedge family medicine. The correction dose regimens are low, medium, high or other dose. The bolus prandial insulin is one half of the tdd split equally before breakfast, before lunch and before dinner meals. Mar 24, 2017 in this video, you will learn how to use the correction factor and insulin to carb ratio on a sliding scale to determine how much insulin to give with a meal. More commonly, the sliding scale is used to determine the dose of rapid or shortacting insulin administered prior to meals, based on the preprandial blood glucose reading andor the expected caloric or carbohydrate intake. Basically, regular insulin was administered based on retrospective amounts of glycosuria. S liding scale regular insulin ssi in themanagementofpatientswithdiabetes was the standard practice as. Specific amounts of regular insulin was administered depending on the colour of the urine from performing fehlings test or benedicts test as described above. 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.

Apr 30, 20 from what i read, a sliding scale of insulin is according to many, very outdated and tends to keep glucose levels higher than optimal. Oct 7, 2014 insulin drug chart for nursing printable sliding scale insulin chart stay safe and healthy. Dont use sliding scale insulin ssi for longterm diabetes management for individuals residing in the nursing home. The sliding scale method does not accommodate changes in insulin needs related to snacks or to stress and activity. Insulin sliding scale dose blood sugar low dose moderate dose high dose 60 110 no insulin no insulin no insulin 111 150 2 units 4 units 6 units 151 200 4 units 8 units 10 units 201 250 6 units 10 units 12 units 251 300 8 units 12 units 15 units 301 350 10 units 14 units 18 units. May 01, 2010 glycemic control in hospitalized patients who are not in intensive care remains unsatisfactory. Use of the nomogram resulted in a significantly greater number of blood glucose measurements, but with fewer physician orders for changes in the insulin. Which is why you can find lots of papers with titles such as sliding scale, time to stop sliding its time to abandon the sliding scale. 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. For sliding scale therapy, this refers to premeal dose, bedtime time high blood sugar correction and background dose understand how different insulin formulations act in your body. Burden of sliding scale insulin use in elderly longterm care residents with type 2 diabetes sliding scale insulin ssi th sliding scale insulin ssi therapy provides a suboptimal approach to glycemic control. Patients should not be prescribed correctional insulin or sliding scale insulin as it is commonly called as the only insulin therapy, but rather should be given a combination of longacting. Pdf clinical outcomes associated with use of subcutaneous.

Continue to repeat 10 units subcut and poc blood until blood glucose is less. Basal versus slidingscale regular insulin in hospitalized patients with hyperglycemia during enteral nutrition therapy editorial. Despite its limitations, ssi is commonly used for patients with type 2 diabetes mellitus t2dm in the longterm care ltc setting. 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. Despite increasing evidence that supports intensive glycemic control in hospitalized patients, blood glucose control continues to be challenging, and sliding scale. Specific amounts of regular insulin was administered depending on. The practice of discontinuing oral diabetes medications andor existing insulin therapy and starting slidingscale insulin ssi results in undesirable levels of hypoglycemia and. These earlier studies used urine glucose for sliding scale, but with. Back in 1934, regular insulin was the only form of insulin available1. We tested the feasibility and the effects of a nursebased bb regimen in orthopedic surgery. Clinical outcomes associated with use of subcutaneous sliding. Glycemic control and sliding scale insulin use in medical inpatients with diabetes mellitus. Started in 1995, this collection now contains 6767 interlinked topic pages divided into a tree. Subcutaneous sliding scale insulin, hyperglycemia, hospitalized patients.

Table 1 shows an example of sliding scale insulin for patients with acute illness recommended in the 11th edition of joslins diabetes mellitus textbook in 1971. Insulin drug chart for nursing printable sliding scale. In most slidingscale insulin therapy regimens, your blood sugar is taken using a glucometer. Correctional bolus insulin is added to the premeal scheduled doses from specific. 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. May 21, 2015 evidencebased information on sliding scale insulin from hundreds of trustworthy sources for health and social care. Evidencebased information on sliding scale insulin from hundreds of trustworthy sources for health and social care. Nursemanaged basalbolus versus slidingscale insulin.

From what i read, a sliding scale of insulin is according to many, very outdated and tends to keep glucose levels higher than optimal. In a sliding scale system, insulin administration is based primarilyiand in some cases, entirelyion a single point in time. Sliding scale insulin has been in use for more than 80 years without much evidence to support its use as the standard of care. Insulin therapy in the outpatient setting american college of. Burden of sliding scale insulin use in elderly longterm care. Slidingscale 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. Insulin sliding scale dose blood sugar low dose moderate dose high dose 60 110 no insulin no insulin no insulin 111 150 2 units 4 units 6 units 151 200 4 units 8 units 10 units 201 250 6 units. In most sliding scale insulin therapy regimens, your blood sugar is taken using a glucometer. Slidingscale insulin diabetes care american diabetes association. Correctional bolus insulin is added to the premeal scheduled doses from specific glucose level regimens.

More commonly, the sliding scale is used to determine the dose of rapid or. The original insulin sliding scale was known as rainbow coverage. Although it can be helpful for some, its effectiveness is questionable, and a good deal of controversy surrounds its use. Several studies have revealed evidence of poor glycemic. Comparison of inpatient insulin regimens with detemir plus aspart versus neutral protamine hagedorn plus regular in medical patients with type 2 diabetes. Fulltext pdf relationship of psychologic factors to frequent symptomatic ventricular arrhythmia. To compare efficacy and safety of traditional sliding scale insulin ssi versus modified 7030 insulin versus basal plus supplemental scale ss insulin regimens for glycemic control of inpatients with diabetes. Feb 19, 2015 sliding insulin scale a patient education video by dr. Picture on the left is a 1934 insulin sliding scale created by elliot joslin. 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.

An increased trend in the use of mealtime insulin, titration of insulin when warranted, 45, and avoidance of sliding scale insulin as monotherapy 34 observed in several of these studies are. Sliding insulin scale a patient education video by dr. Sliding scale insulin is sometimes used by doctors to help regulate a patients blood sugar levels. Clinical outcomes associated with use of subcutaneous sliding scale. Evaluation of slidingscale insulin versus basalprandial. Glycemic control in hospitalized patients who are not in intensive care remains unsatisfactory. Despite recommendations on the use of insulin analogs in elderly patients with t2dm, the use of regular insulin and sliding scale insulin ssi regimens continue to be commonplace. For sliding scale therapy, this refers to premeal dose, bedtime time high blood. Sliding scale insulin use has been associated with severe hypoglycemia, particularly in. These results suggest that a basalbolus insulin protocol can reduce hypoglycemia. 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. For intensive insulin therapy, this means your insulin tocarbohydrate ratio, blood glucose correction and background dose.

Full text use of basal insulin and the associated clinical. The idea stemming from the concept of chasing the rainbow. History of sliding scale eradicating insulin sliding scales. We limited the nphintermediate insulin to a maximum of 20 units in 12 h. Clinical evidence for glucose control in the inpatient. In this video, you will learn how to use the correction factor and insulin to carb ratio on a sliding scale to determine how much insulin to give with a meal. Pharmacotherapy for hyperglycemia in noncritically ill. 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. This is done about four times a day every five to six hours, or before meals and at bedtime. In the united states, approximately 26 million people have diabetes mellitus, including 10. Which is why you can find lots of papers with titles such as. The dose of basal insulinia longacting or twiceaday intermediateacting insuliniis sometimes given on a sliding scale. Burden of sliding scale insulin use in elderly longterm care residents with type 2 diabetes sliding scale insulin ssi th sliding scale insulin ssi therapy provides a suboptimal approach to glycemic.

Administer 14 units subcut, notify provider, and repeat poc blood sugar check in 1 hour. Sliding scale insulin is generally defined as a set of instructions for administering insulin dosages based on specific. Using sliding scale to determine insulin dose youtube. Please practice handwashing and social distancing, and check out our resources for adapting to these. For intensive insulin therapy, this means your insulintocarbohydrate ratio, blood glucose correction and background dose. Glycemic control in hospitalized patients not in intensive. Jul 18, 2011 patients should not be prescribed correctional insulin or sliding scale insulin as it is commonly called as the only insulin therapy, but rather should be given a combination of longacting and fastacting analogs to meet their insulin requirements. A slidingscale ss regimen is discouraged to correct hyperglycemia in hospital patients, but there is resistance to adoption of basalbolus bb treatment in surgical units. Pdf comparison on efficacy and safety of three inpatient insulin. Continue to repeat 10 units subcut and poc blood sugar checks.

Comparison on efficacy and safety of three inpatient insulin. Sliding scales are less effective in covering a premeal high blood sugar, because the high blood glucose correction and food bolus cannot be split. Highlight guidelines specific to initiating insulin therapy in type 1. In those patients whose blood glucose remained greater than 180 mgdl, we used a twice daily regimen of intermediate acting insulin together with insulin amounts on a sliding scale to keep the blood.

Administer 12 units subcut, notify provider, and repeat poc blood sugar check in 30 minutes. To compare efficacy and safety of traditional sliding scale insulin ssi versus modified 7030 insulin. Despite persistent expert recommendations urging its abandonment, the use of sliding scale insulin. Several studies have revealed evidence of poor glycemic control and deleterious effects in sliding scale insulin use.