Stepwise dosing and titration of insulin for type 2 diabetes in the ambulatory setting last update 52010. The citrate dose was titrated by sliding scale to target circuit. This amount is only what is required to get the blood sugar back to target level and does not cover any additional carbs from a nonprescribed bedtime snack. When using a sliding scale it is important to eat the same amount. Adult sliding scale for insulin aspart novolog page 1 of 1 source. Correctional subcutaneous sliding scale insulin to be administered indicate frequency. To ensure patients who are discharged with diabetic medication requiring a sliding scale, the correct order must be placed.
I use a sliding scale of humalog at mealtimes and i use 14 units of lantis each evening. Sliding scale what is sliding scale insulin therapy. Administer within 15 minutes before a meal or immediately after a meal. Insulin lispro u100 humalogr may be diluted with insulin diluting medium for humalog to provide concentrations of u10 or u50. You may need medicines in addition to healthy eating and exercise habits to handle your type 2 diabetes. Stepwise dosing and titration of insulin for type 2 diabetes. Usual suggested starting point for most patients, including those being initiated on tpn moderate dose scale.
The sliding scale group was treated using ad hoc sliding scale infusion therapy. The use of the sliding scale insulin regimen was first introduced by elliot joslin in 1934. An intensive insulin regimen includes a basal dose and two bolus doses. Correction insulin sliding scale, supplemental, bolus. Insulin dosing worksheet sliding scale insulin to carbohydrate ratio 1 unit. Weightbased, lowdose pediatric wholebody petct protocols. Insulin aspart novolog slidding scale, very resistanthigh for blood glucose 60149. Lantus insulin glargine, a longacting insulin is used for treating type 1 q. Formulas commonly used to create insulin dose recommendations this example illustrates a method for calculating of your backgroundbasal and bolus doses and estimated daily insulin dose.
Individualize dose based on metabolic needs and frequent monitoring of blood glucose. Calculating insulin dose diabetes education online. Goal blood glucose is apr 05, 2019 sliding scale insulin therapy involves creating and following an individual chart. Amy coxdiabetes basalbolus vs sliding scale insulin in the hospital insulin chart, nursing. In slidingscale insulin therapy, the dose is based on your blood sugar level. Because at night only the amount of insulin needed to cover the snacks before going to bed. Receives 6 u insulin sliding scale 6 u insulin sliding scale correction factor for 75 g of carb for lunch 15 g of carb for lunch blood sugar before dinner 245 blood sugar before dinner 60. You can take lots of diabetes medications by mouth. You will need to calculate a total daily dose if needed. 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. The big diabetes lie blood sugar chart diabetes doctors at the. This drug might help you lose a small amount of weight.
If patient has low glucose levels associated with exercise. Metformin lowers the quantity of glucose that your liver makes and helps your body usage insulin much better. Rx insulin sliding scale aspart before meals low rx low dose insulin sliding scale rx medium dose insulin sliding scale blood sugar high dose 60110 111150 151200 20 1250 250 3050 350 no insulin 6 units 10 units 12 units 15 units 18 units 20 units call md. If you need to use correction insulin daily, for three or more days in a row, call your health care team. Many people believe that diabetes is a condition that elevates their blood sugar levels. Barbara davis center serves more than 90% of colorado children diagnosed with type 1 diabetes. According to the search for diabetes in youth study, over the past ten years bdc provided care to 3,222 of the 3,500 children who were diagnosed in colorado. Humalog u100 or u200 administer the dose of humalog u100 or humalog u200 within fifteen minutes before a meal or immediately after a meal by injection into the subcutaneous tissue of the abdominal wall, thigh, upper arm, or buttocks. Slidingscale insulin regimens when administered alone were associated with a threefold higher risk treatment of type 2 diabetes mellitus in the older patient view in chinese administered immediately after a meal to better match the meal size and minimize hypoglycemia. Furosemide oral sliding scale in heart failure hf sample dosing ideas for managing otherwise stable hf patients 1,2,3. Sitagliptin once daily dosage 100 mgday at any time of day for patients with gfr 50100 mlmin.
To see if you are eligible, find your family in the table below. Intensive insulin therapy diabetes education online. 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. Find out how it works and learn about problems with this diabetes. Can lantus be used as a sliding scale with my current insulin of. Sitagliptin group discontinue oral antidiabetic drugs or low dose insulin on admission. Umc health system patient label here sliding scale.
Correctional subcutaneous sliding scale insulin to be administered indicate. Umc health system patient label here sliding scale insulin regular plan physician orders place an x in the orders column to designate orders of choice and an x in the specific order detail boxes where applicable. Administer the dose of humalog u100 or humalog u200 within fifteen minutes before a meal or immediately after a meal by injection into the subcutaneous tissue of the abdominal wall, thigh, upper arm, or buttocks. Lispro goal blood glucose is 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. Use glycemic controlsubcutaneous orderset and order correctional scale insulin order for patient condition to get correct scale for admin instructions. Calculate insulin dose for food add up all the carbohydrates in your meal. Lantis is a 24 cylce insulin or a long acting insulin where humalog is short term or short acting insulin. Order order details 010 units, subcut, inj, q6h, prn glucose levels see parameters low dose insulin regular sliding scale. Most people with type 2 diabetes start medical treatment with metformin. In sliding scale insulin therapy, the dose is based on your blood sugar level. Barbara davis center home university of colorado school of. 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. Once the order is placed, the sliding scale will appear on the avs.
However, total cost of insulin pen is potentially lower than vial if patients daily insulin dose is low since less unused insulin needs to be discarded at end of month. Slidingscale regular insulin ssi in the management of. For intensive insulin therapy, this means your insulintocarbohydrate ratio, blood glucose correction and background dose. An individualized correctional scale may be necessary for patients with extremely low or high insulin tdds 126 units. Low glucose levels may occur during or after exercise. Suggested for insulinresistant patients and those receiving high dose corticosteroids high dose scale. Slidingscale versus basalbolus insulin in the management. Sliding scale insulin protocol follow ssi reference text medications medication sentences are per dose. Adult sliding scale for insulin regular novolin r umc health.
If npo check blood glucose every 6 hours blood sugar mgdl. Weightbased, low dose pediatric wholebody petct protocols adam m. Sliding scale insulin therapy involves creating and following an individual chart. Many people with type 2 diabetes start medical treatment with metformin tablets. Sliding scale insulin regimens for type 2 diabetes using multiple daily injections.
The term sliding scale refers to the progressive increase in the premeal or nighttime insulin dose. The term sliding scale refers to the progressive increase in premeal or nighttime insulin doses. 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. Completing more than 20,000 ambulatory encounters per year, bdc is the largest outpatient. You may not need correction insulin at the meal before or after you exercise. Slidingscale insulin diabetes care american diabetes association. Sliding scale insulin refers to a treatment regimen that provides no basal insulin and provides only short acting insulin if needed according to blood glucose test results. The total lunch insulin dose is 8 units of rapid acting insulin. Low dose or moderate dose doses for bedtime are also reduced to prevent hypoglycemia moderate dose 20 acins as listed in various insulin orders refers to a dropdown box in poe listing the hospital standard. Find out how it works and learn about problems with this diabetes treatment. Correction dose insulin low dose or moderate dose low dose there are 2 options for the correction dose sliding scale. Optimizing glucose management in hospitalized patients. Humulin n, novolin n insulin nph dosing, indications.
Premixed insulin doses are based on the blood sugar level before the meal. In this section, youll find handouts, illustrations, and links organized by topic. Regional citrate anticoagulation for continuous renal. Sliding scale regular or humalog insulin uw health. Sliding scale users must keep the following in mind. Guide to starting and adjusting insulin for type 2 diabetes. Do not take correction insulin more often than every 46 hours unless you have been told to do so. Insulin aspart novolog slidding scale, very resistanthigh for blood glucose sliding scale comments 60149. The nomogram allowed changes based on both the blood glucose concentration and the concurrent insulin dosage. Randomized study comparing a basalbolus with a basal plus.
But this just shows you that different people have different needs. The identification and rating of the body of evidence to support the type 2 diabetes insulin guidelines. The effective dose is the accepted dose metric for quantifying the stochastic risk of carcinogenic or genetic effects and is an effective method to compare relative radiation dose from different imaging techniques 18. Table 1 shows an example of sliding scale insulin for patients with acute illness recommended in the 11th edition of. Novolog sliding scale insulin chart insulin chart, diabetes. Divide the total carbohydrates by the insulin to carbohydrate ratio. A moderate scale would be used for patients requiring a tdd of 4384 units, and a high dose scale should be ordered for patients requiring 85126 unitsday. Sitagliptin once daily dosage 100 mgday at any time of day for patients with gfr 50100 mlmin 50 mgday for patients with gfr 3050 mlmin supplemental correction insulin. Diabetesreversing diabeteswhat causes diabeteslow blood sugar levels. Stepwise dosing and titration of insulin for type 2.
When diabetes isnt diagnosed and treated early on, it can wreak havoc on the. The term sliding scale refers to the progressive increase in the premeal or nighttime insulin dose, based on predefined blood glucose ranges. If blood glucose is 60 or below, notify physician, as about d 50%. 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. Intensive insulin regimens attempt to mimic the bodys normal pattern of insulin secretion, and deliver replacement insulin using the concepts of basal and bolus insulin coverage. Parisi1,2 1department of radiology, university of washington, seattle, washington. Jan 31, 2020 in slidingscale insulin therapy, the dose is based on your blood sugar level. Adult sliding scale for insulin aspart novolog umc health system. Blood glucose level target blood glucosecorrection factor units insulin to be given example. Sliding scale and basalbolus insulin regimens are two options available for the treatment of severe or acute hyperglycemia in type 2 diabetes mellitus patients. Adult sliding scale for insulin regular novolin r page 1 of 1 source.
A sliding scale prescription may include a bedtime correction dose. To improve glycemic control in adult patients with diabetes mellitus. Sliding scale coverage usually begins after blood glucose 11 mmoll 200 mgdl if coverage is needed q4hr for 24 hr, then base insulin dose is adjusted first. Used rarely except for patients with severe insulin resistance. The intervention group was treated using a dosing nomogram that was managed by a nurse. Other oral medications act in different ways to lower blood sugar. Insulin orders for patients with type 2 diabetes order set.
Historically, sliding scale regular insulin was the issue now rapid acting insulins are a concern. Research design and methods this multicenter trial randomized 375 patients with t2d treated with diet, oral antidiabetic agents, or low dose insulin. Improving glycemic control in the noncritical care setting nyspfp. Optimizing glucose management in hospitalized patients using. To reduce the risk of lipodystrophy and localized cutaneous amyloidosis, rotate the injection site within the same region. Short bowel syndrome orphan orphan designation for. Lispro goal blood glucose is scale, very resistanthigh for blood glucose sliding scale comments 60149. Type 1 diabetes forpatientswithtype1diabetes,dosing insulin based solely on premeal glucose levels does not account for basal insulin requirements or calorie intake, increasing both hypoglycemia and hyperglycemia risks and potentially leading to diabetic ketoacidosis. Sliding scale therapy approximates daily insulin requirements. Sliding scale coverage usually begins after blood glucose 11 mmoll 200 mgdl if coverage is needed q4hr x 24 hr, then base insulin dose is adjusted first. Glycemic controlsubcutaneous regimen adjustment 1758.