Q&A Diabetes » Q and A for Diabetes » sliding scale insulin

sliding scale insulin

A: I assume that you are talking about units of insulin that your dad uses.

First off, I’d say that sliding scales are not recommended by endocrinologists – this is because you end up chasing the blood sugar levels and it’s quite difficult to get the insulin dosing right using this method. The method usuall recommended is to adjust insulin doses using the previous days readings, hence it’s proactive rather than reactive.

Secondly, if your dad is using 30-90 units per day, that is not really that much in the range of experience of type II diabetics. If he’s been told he’s a type I diabetic (insulin deficient)… well, he’s probably developing type II features as well (insulin resistant) and hence needing higher doses of insulin.

If he’s using 30-90 units EACH TIME, then it’s actually quite high doses. The highest requirement I’ve seen is in the range of 200 units per day, but some may well need more than this. It means that the body’s resistance to the effects of insulin is extremely high. The bottom line is that we monitor the appropriateness of dosage by the blood sugar levels – too high doses result in hypoglycemia.

Q: How should you take your scheduled insulin if you had to take a sliding scale insulin for a high blood sugar?

A: Take your scheduled dose on time. No matter what, you should never miss your dosing, as it can cause you to spike again later.

Q: Why can’t sliding scale insulin be given to NPO inpatients?
NPO meaning the patient can’t eat anything by mouth. They might be on IV or a feeding tube, but they can’t physically eat for themselves =)

A: If they have an enternal feeding and are diabetic they are typically placed on a sliding scale dpending on their blood sugar control. If they are on TPN/PPN intravenously, they can be given a sliding scale and routinely are.

Whoever told you they couldnt is grossly incorrect.

Q: Taking off of sliding scale insulin; safe?
Well to start out with the question is just curiosity and would not be taking without a doctors advise, but I am curious to see if this is a common practice among nurse practitioners. My Mother has been taking 24 hour and sliding scale insulin for over 7 years. She went to see a new doctor because of insurance issues and a nurse practitioner saw her and took her off the sliding scale insulin and put her on a pill. Also put her on a baby aspirin regiment which she had never been on. My biggest worry is how her sugar acts, its very low and very high at times there is no common with her. I do not want to see her in the emergency room over a mistake. Any input or concerns would be appreciated.

A: the baby aspirin is to keep her blood thinner than normal to help with her high blood pressure thats one. the other things is her pancreas may be creating enough insulin to keep her sustained enough to provide a balance. However if that is not the case the first 24 hours will be the leading factor if her blood sugar starts to go high and keep climbing no matter what you do call 911. The reason is her body may not be creating enough insulin to keep her level. Sometimes a sliding scale can be a good balancer however it depends on the insulin and ther person. I was on lantus a 25 hour insulin and I felt horrible and it sucked now I am on levemir which provides a better balance for me.

Q: what insulin units on sliding scale mean?
You are also to give Humulin-R insulin 8 units (according to the sliding scale) and Humulin 70/30 insulin 36 units sub cu. q.am

A: To me, this means that you need to be able to count the number of grams of carbohydrates that you will eat at each meal, and inject an amount of insulin that will be able to handle that amount.

This is often expressed as a ratio – such as 1 unit of insulin for each 5 grams of carbohydrates, or 1 for each 10 grams. You can end up injecting a different amount of insulin at each meal depending on what you will be eating.

That requires two very important things, however:
1) that you have been given proper education by a diabetes educator on how to read nutrition labels and properly estimate food quantities so that you can properly count the grams of carbs in each meal and snack.

2) that you and your doctor, or a diabetes educator, have figured out what the proper insulin to carb ratio is for you. It will vary from person to person and you cannot generalize about what might work. Sometimes, the ratio will vary according to time of day: in the morning, perhaps the ratio is 1 to 3, for lunch and dinner, however, it might be 1 to 6. This really has to be worked out over time, by keeping very careful records of what you eat (and how many carbs are in each meal), how much insulin you inject, and what the blood sugar measurements are before, and two hours after, every meal. The doctor could suggest a ratio for you to try, but it is only by careful carb estimates and faithful recording of sugar levels that you will find out if those ratios work or need adjustment.

The other factor involved is a correction factor. If you start a meal with you blood sugar at 100, then the proper insulin to carb ratio usually works out OK. However, sometimes the glucose level before a meal will be much higher (happens to almost everyone sometimes). In that case, you would add some additional units to the amount that you calculate form the ratio. It might be something like: 1 additional unit for each 30 points that the glucose is over 140 (using US units, don’t know the mmol equivalent). So, if you measured 170, you would calculate the usual insulin dose from your standard insulin to carb ratio, then add 1 unit as a correction.

If you started the meal at 200, then you would add 2 units… and so on.

It takes some effort, but it is absolutely worth it to achieve good control and to manage the disease properly. With good management, you can live a good, long, healthy life.

Q: Are you using a “sliding scale” in determining how much insulin you need to take?
I can always ask my doctor, but I was just wondering how anyone here handles it if that’s what they’re doing.

A: Im diabetic but not on insulin, but I have seen it used many time in hospital with post op patients. Its very effective and gets the blood glucose back to normal in the shortest possible time. If you are considering doing it you need medical advice anyway to determine the dosing levels.

Q: Doctors, have you ever ordered long acting insulin for sliding scale coverage, i.e. NPH? Concerned nurse.?
Need answer asap, small town no doctors, alone.

A: I am a nurse and have NEVER used NPH for sliding scale insulin – only short acting regular insulin is used for this normally. Maybe this was an error, either in writing or by the pharmacy. I would call tomorrow and ask if this is right.

Q: What time does the nighttime protocol for sliding scale go into effect?
Help! I’m in nursing school, taking on-line classes, and cannot find ANYWHERE at what time the nighttime protocols go into effect for sliding scale insulin. I am trying to answer an assignment question that asks what my intervention would be for a FS prior to supper of 225. I don’t know if I should use the daytime sliding scale or the nighttime sliding scale. Also (another question I can’t find the answer to), if the FS @ 1700 is 200, using the moderate sliding scale for regular insulin with 20 units of NPH ordered for AM & 14 units of NPH ordered for PM, would that alter the PM dose of 14 units of NPH? I hate to ask for the answer, but my on-line class does not offer much in the way of support by teachers. I prefer to figure answers out on my own, but this one has me stumped. I would appreciate an explanation, not just an answer, as I am really trying to learn here.

Thanks!

Frustrated nursing student.

A: 1) Daytime sliding scale-because the patient is going to eat. The nighttime scale is for when your patient is sleeping and therefore not going to eat. You need to keep in mind the reason WHY you are giving insulin. It is to facillitate the usage of insulin into the cells.
2) No, it would not affect the pm dosage ordered and you would give it as ordered. NPH insulin is what is called intermediate acting insulin. The onset of such insulin is 2-3 hrs. The peak is 8-12 hrs and the termination is 18-24 hrs. So lets assume that your pt has had a fingerstick that morning at approx. 5am. Lets assume that the fingerstick was as expected and the pt was covered under the sliding scale with regular insulin and then give the 20 units of NPH as scheduled. Now, it is 12 hours later and you are the nurse. You get the fingerstick at 1700 and it is 200. At this time the NPH insulin FROM 5 am would still be working to influence the pt’s blood sugar.You would give regular insulin (short acting) at that time to cover the pt’s blood sugar at that time. You would then give NPH as scheduled, usually at bedtime because that insulin acts over a longer period of time, ie until 5am when the morning fingerstick is due.
NOW if at 1700, you got a BS of 60, you would assume that the pt is getting too much NPH in the morning and bring that to the doc’s attention. If the pt blood sugar was say 35 in the morning, you would want to consult the doc and consider reducing the nightime NPH dose or possibly holding it. Does this help? When doing insulin questions, always say to yourself, what is this insulin designed to do and why am I giving it to the patient. Isn’t nursing school fun? For additional help, check out “Allnurses.com”. email me if you get stuck again.

Q: Where can I find a diabetic sliding scale chart online?
I lost my chart and need to know how much insulin to take when my sugar is high.
For example 3 units when my sugar is 200 or over up to 5 units up to sugar level 210 etc. I can’t remember what I should do because Im fairly new at this insulin taking.

A: DO NOT use a chart you find online.

Every person’s insulin sensitivity is different and if you use a chart that was made for a different person it could have disastrous results. Call your doctor and ask for your chart, or at least your correction ratio. If you know your correction ratio (ie 1 unit of insulin will bring your blood sugar down by X amount) you can re-create the chart yourself.

Q: When you take insulin before meals, do you take it before snacks like at bedtime too?
My doctor told me to take insulin on a sliding scale before meals, but I don’t remember whether he told me to do it before the snack at bedtime.
I do 3 small meals and 1 snack at bedtime and have to check my sugar levels to see how much insulin I have to take before I eat, but what about before the snack?

A: The reason generally that you have a snack before bedtime is so you don’t get low overnight. If you are taking a long acting insulin, that’s generally the one you would do at night time. There are a lot of different variables though. Talk to your dr.
It can be so overwhelming at first. Its best to get off on the right foot, try your best, it will be worth it down the road. Hope you get things worked out

Q: Sliding scale question?
im using sliding scale and was wondering if i check my blood sugar and it hi and i take my insulin according to the scale then check it 2 hrs later and it is still hi but not as hi should i take more medicine or waite and check it again?

A: what kind of insulin are you taking? Humalog is the fastest acting insulin there is. If that is what you are taking (it’s very common among type one diabetics) then you should be taking it 30 minutes BEFORE you eat, that way the insulin peaks when your blood sugar is peaking from the food you consumed. Humalog stays in your system for up to 4 hours! So if you are checking your blood sugar 2 hours after you eat it could very well be that the humalog hasn’t finished working. My endocrynologist suggests I don’t try to correct my blood sugar for that exact reason. If you correct your blood sugar 2 hours after you just took insulin I can almost guarantee your blood sugar will go low. Talk to your physician and see what he or she thinks!

Q: do you need to use a sliding scale when useing 70/30 insuliln?
okay one Saturday my grandma blood sugar dropt down to 51 so she had to go to the hospital for 3 days the did not let her take any other drug other than insulin. so to day here’s what happened
time blood sugar units of insulin
9:58am 177 3
3:11pm 179 3
7:10pm 240 6
9:39pm 253 none
11:14pm 247 none
so if you can help us ASAP!

A: Honestly, I have no idea how people can get by with that 70/30 stuff…it’s just so imprecise, and in situations like your grandma’s (which is very typical), you have no control over the situation. Is there a way to get a hold of her doctor to see if you could switch her to a different insulin regimen, preferably using Humalog/Novolog as her fast-acting, and Lantus as her long acting? If your doc is clueless about why that combo would be better, please get her an appointment with an Endocrinologist (gland doctor), who specializes in insulin-treated diabetes.

It would take some effort and some trial-and-error to get her transitioned, but once she’s adjusted she’d do so much better because she could give herself a little more Humalog when she’s high, without worrying about going low at some point later in the day from too much baseline insulin.

Q: Do you take your short acting insulin with you to a restaurant?
I’m newly diagnosed diabetic. I have to use lantus once a day and novolog on a sliding scale at meals and bedtime. Today is the first time I’m going to a restaurant for lunch. Should I take insulin and go in restroom and test and inject if needed? I never see anyone injecting themselves at restaurant tables. Do you take in restroom or just not take insulin at all? I really don’t want to look stupid. What do you do?

A: I just inject under the table.

At a restaurant you’ll need your insulin, because you’ll eat more than normal.

Just inject as usual, and no-one will notice, or care.

I never do it in a rest room, far too unhygienic.

Don’t let anyone tell you you can’t do it.

Good luck. No-one should ever make you feel bad because of your illness.

Q: Sliding scale Diabetes?
My friend is newly diagnosed diabetic, anyway she asked me this question, and I don’t know what to say. Anyways, I can’t remember the exact units, but this is how this thing goes.
She was instructed to take 10 units of regular insulin before breakfast… this is routine.
Then additional order comes with the sliding scale.
If her blood glucose is of a certain range she should take a prescribed amount of units.
Let’s say if her blood glucose is 250 mg/dL, she should take 15 units.

Now, what if she wakes up in the morning before taking breakfast and her blood glucose is 250, should she take 15 units + the pre-breakast dose 10 units= 25 units
or should she just take the prebreakfast dose= 10 units
or just the 15 units dose?

What is it really?
And usually, how much units of insulin is considered too much? Any nurse or doctors or whoever…
Thanks, I’d appreciate it if it comes with an explanation.
I researched yahoo answers first before I posted this question… Unfortunately Kalie, I already read that same answer. Thanks anyways.
Any direct answer to my primary question?

Thanks in advance

A: Well, first and foremost, she should contact the doctor that put her on this system if she has specific questions about it.

I’ve been on a sliding scale for a while – this means that I make adjustments based on what my blood sugar is and what I am going to eat. You’ve got the general idea of it.

Her doctor should have given her a formula to correct for high blood sugars. My formula was “High Blood Sugar Number-120/40″. So if my blood sugar was 250 and I did that math (250-120/40) I would need to take 3.25 units of Novolog (a fast acting insulin) to correct for it. Meaning, Taking that much insulin would bring my blood sugar down to approximately 120, which is my goal number.

As for food, I was on a 10:1 carbohydrate to insulin ration. So if I were to have a slice of toast in the morning that contained 10 grams of carbohydrates then I would take one unit of insulin (again, the fast acting Novolog) in order to eat it.

Now what you have her listed as doing sounds a little…extreme. If she is on Novolog then 15 units of insulin is waaaaaay too much for a high blood sugar and breakfast. Unless, of course, she was eating about 150 grams worth of carbohydrates for breakfast! I don’t think you’re going to get a clearer answer until you correct your question with what kind of insulin she is on.

But really if your friend is confused about her treatment plan then have her call her doctor. You’re not going to get accurate advice here on yahoo answers. :) We don’t know your friend’s case – her doctor does.

ETA: don’t pay attention to what Kalie says. I don’t think she understands how diabetes works! There is no way to truly be ‘proactive’ when it comes to type one diabetes. High blood sugars are going to happen, no matter how ‘proactive’ you are. The treatment plans out there right now are more precise, but they’re still imperfect tools. The sliding scale is a good way to get into better control – I took my A1c from an 8 down to a 6.7 with it.

Q: question about sliding scale?
doc just put me on a different insulin,levemir. on my instructions it says BS-100/30 = UNITS OF INSULIN. does that mean i divide 30 from what ever my blood sugar is and that is what i take? like if my blood is 500 i divide 3o from 500?

A: Levemir is a basal insulin. They are typically used to help counteract the sugar that the liver produces and the amount taken shouldn’t very from day to day. Call the doctor’s office and ask what they meant by that. It’s best if you don’t guess.

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