Correctional subcutaneous insulin select one insulin aspart novorapid or. Insulin sliding scale, correctional insulin dosing. Sliding scale insulin therapy involves creating and following an individual chart. Learn sliding scale insulin with free interactive flashcards. Implementing an intravenous insulin infusion protocol in. Stepwise dosing and titration of insulin for type 2.
Historically, sliding scale regular insulin was the issue now rapid acting insulins are a concern. Getting your patients off the slidingscale insulin roller. 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. Changes in insulin strength, manufacturer, type, or method of administration may result in the need for a change in insulin dose or an adjustment in. Heres a look at how two hospitalists use these strategies in their daytoday practice. When prescribing insulin, cross reference on the in patient prescription chart eg insulin as per chart. Insulin pens are supplied in boxes of 5 pens each containing 3 ml at 100 units insulin per ml. I then turned to the literature and performed a medline search from 1987 to 2000 using the words sliding scale insulin. Burden of sliding scale insulin use in elderly long.
Correction insulin sliding scale, supplemental, bolus. Sliding scale insulin refers to a treatment regimen that. Seventythree faculty members, 1 residents, and 191 nurses from four hospitals completed a 20. Pdf slidingscale and basalbolus insulin regimens are two options available for the treatment of severe or acute hyperglycemia in. Hypoglycemia is the most common adverse effect of insulin therapy. Pharmacotherapy selfassessment program, 6th edition 1 diabetes in children and adolescents learning objectives 1.
Among the many insulin management systems that have been developed, none has been as widely used as the sliding scale. 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 12 units subcut, notify provider, and repeat poc blood sugar check in 30 minutes. Premixed insulin doses are based on the blood sugar level before the meal. Modify insulin regimens cautiously and only under medical supervision. Monitor blood glucose in all patients treated with insulin. Find out how it works and learn about problems with this diabetes. Insulin choices, effect of insulin degludec vs insulin glargine u100 on, insulin log template overweight management. Can lantus be used as a sliding scale with my current insulin of.
Choose from 49 different sets of sliding scale insulin flashcards on quizlet. Distinguish between various forms of diabetes mellitus dm that can affect children including type 1 dm, type 2 dm, hybrid diabetes, and maturity onset diabetes of the young. This use of sliding scale basal insulin is a sad commentary about how poorly as a group clinicians understand basic principles of insulin therapy. A nomogram for intravenous insulin infusion in critically ill patients was evaluated in a retrospective beforeafter cohort study. Insufficient knowledge of insulin contributes to errors in its use that may cause adverse patient outcomes. I am also decreasing her humalog sliding scale prior to meals. At the university of washington, a systemwide protocol has been followed that has worked well and perhaps as importantly, taught physicians and physicians in training the basic principles of insulin. Lantus insulin glargine, a longacting insulin is used for treating type 1 q. Insulin sliding scale chart levemir sliding scale, insulin and glucagon regulate pancreatic pdf download, insights into veterinary endocrinology. Although the actual form is the same, requirement and attachments for each category is different. This work was presented, in part, at the annual meeting of the american medical directors annual meeting in louisville, ky, march 1922, 2015. This humalog sliding scale sliding scale assumes that unit of humalog will lower the blood.
Pdf evidence for basalbolus insulin versus slide scale. The sliding scale group was treated using ad hoc sliding scale infusion therapy. Insulin, given either intravenously or subcutaneously, is the preferred regimen for effectively treating hyperglycemia in the hospital. Differentiate between traditional insulin and basal. Take the average hourly insulin infusion rate over the. Pdf two sliding scale regular human insulin rhi algorithms ssi were retrospectively evaluated to identify those who develop severe hyperglycemia. These documents are available to download from the abcd website at. Under witness, select record new entry the nurse verifying the correct insulindose was drawn up, records hisher initials. Educational tools eradicating insulin sliding scales. 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. Poor control of diabetes mellitus dm in hospitalised patients is associated with worse clinical outcomes. Tips for calculating a total daily dose of insulin today. Inpatient diabetes treatment has become more complicated recently with the introduction of new insulin formulations and a new emphasis on tight blood glucose control.
Glucose monitoring is recommended for all patients with diabetes. The higher your blood glucose the more insulin you take. Sliding scale regular humulin insulin physician order set. When deepak asudani, md, a hospitalist at baystate medical center in springfield, mass.
Sliding scale insulin vs basalbolus insulin therapy in longterm care. Donner said that the fixed amount of longacting insulin strategy actually outperformed the use of sliding scale insulin alone. The overwhelming consensus in the literature 3,4,5,6,7,8,9,10,11,12,14 is that sliding scale insulin is neither efficient nor effective. Slidingscale insulin treatment was reserved for a bg concentration of 200 mgdl, and insulin drips were instituted at the physicians discretion, with 150200 mgdl as the target bg range. Sliding scale insulin vs basalbolus insulin therapy in. One group received sliding scale insulin, while the other group received a set dose of longacting insulin with no sliding scale insulin.
The sliding scale insulin ssi therapy used for control of inpatient hyperglycaemia is largely ineffective in controlling inpatient blood glucose levels, and guidelines now advocate the use of basal bolus insulin bbi therapy. Its time to abandon the sliding scale mdedge family. In slidingscale insulin therapy, the dose is based on your blood sugar level. This page includes the following topics and synonyms. Optimizing glucose management in hospitalized patients. A 21day randomized controlled trial comparing efficacy, safety and feasibility. In most ssi treatment regimens, a patients blood sugar is measured using a. Sliding scale insulin ssi, a treatment regimen that has been around since the 1930s, is most often used in hospitals.
At this institution, acceptance by both nurses and physicians was. Sliding scale insulin regimens for type 2 diabetes using multiple daily injections. Gestational diabetes mellitus gdm diabetes diagnosed in the second or third trimester of pregnancy that was not clearly overt diabetes prior to gestation 4. In group i short acting insulin was given intravenously using a sliding scale, post insulin after 90 minutes f18 fdg radiotracer injection was given and petct scan.
Standards of medical care in diabetes2019 abridged for. This regimen attempts to control blood glucose levels with doses of regular insulin every 6 hours, with the dose calculated on the basis of the value of capillary blood glucose measured at the. An easy sliding scale formula paul s denker, david r leonard, paul e dimarco, patricia a maleski diabetes care feb 1995, 18 2 278. Order order details 010 units, subcut, inj, q6h, prn glucose levels see parameters low dose insulin regular sliding scale. Sliding scale requires a bit more patient investment than. Use of slidingscale insulin in medical patients at hamad.
Where do you, insulin chart for nursing school pdf file by nursenacole, practical guide to insulin therapy in. Hyperglycemia commonly results from reliance on only sliding scale insulin to control blood glucose, a failure to optimize treatment by increasing the dose of insulin, dosing errors, and dose omissions. View enhanced pdf access article on wiley online library html view download pdf for offline viewing. Any change of insulin dose should be made cautiously and only under medical supervision 5. The impact of basal bolus and sliding scale insulin. We would like to show you a description here but the site wont allow us. Pdf sliding scale regular human insulin for identifying critically. Insulin, particularly when given intravenously or in settings of poor glycemic control, can cause hypokalemia. The sliding scale method is more precise than fixed dose insulin in that it takes account of the fact that peoples blood glucose is not always in the normal range before meals. Sliding scale insulin is an historical artifact dating back to the days of.
This is a reactive way of managing hyperglycemia and should not be used as the sole means of controlling blood glucose unless absolutely necessary. Insulin pens appear similar to one another despite containing different insulins. To examine prevalence, practice patterns, and associated burden of sliding scale insulin ssi therapy in elderly adults with type 2 diabetes t2dm. Patients in a mixed medicalsurgical icu were compared during two 9 month periods. 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. 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. Umc health system patient label here sliding scale. Yellin about our approach whom we serve frequently asked questions. Sliding scale insulintime to stop sliding diabetes. Overview of point click care electronic medical record. Pdf slidingscale versus basalbolus insulin in the management. Adult sliding scale for insulin aspart novolog umc health system. They prefer to invest their idle time to talk or hang out. Despite the lack of evidence of effectiveness of slidingscale insulin ssi, it remains a common practice in hospital settings.
Insulin is consistently among the top five medications associated with administration errors in the hospital setting. The principal difference between the two strategies is that slidingscale insulin does not deliver adequate glycemic control to patients and addresses hyperglycemia. 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. 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.