Can lantus be used as a sliding scale with my current insulin of. Student will draw up or dial appropriate dose of insulin. Splitmixed both insulins provide potential basal and prandial effects. For example, 200 units of u500 insulin would be measured by drawing up 40 syringe units on the u100 syringe. In any large hospital that cares for acutely ill patients with diabetes mellitus, particularly if it is a teaching hospital, one will find many patients treated with the socalled sliding scale of insulin use. This regimen attempts to control blood glucose levels with doses of regular insulin every. Sliding scale insulin ssi is frequently used for inpatient management of hyperglycemia and is associated with a large number of medication errors and adverse events including hypoglycemia and hyperglycemia. Registered nurses can delegate a wide range of tasks, including sliding scale insulin.
Sliding scale insulin for noncritically ill hospitalised adults with diabetes mellitus. Get a printable copy pdf file of the complete article 2. If you need to use correction insulin daily, for three or more days in a row, call your health care team. Basalbolus versus sliding scale insulin therapy in the. Administer 12 units subcut, notify provider, and repeat poc blood sugar check in 30 minutes. 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. Apr 05, 2019 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 the body. Using sliding scale to determine insulin dose youtube. Do not take correction insulin more often than every 46 hours unless you have been told to do so. For sliding scale insulin, a resident who is stable may only require general supervision, whereas, a resident who is unstable getting. You may need to learn how to use a sliding scale plan, or an insulintocarbohydrate ratio, to figure out your dose. In most sliding scale insulin therapy regimens, your blood sugar is taken using a glucometer. Full text is available as a scanned copy of the original print version. Adult sliding scale for insulin aspart novolog umc health system.
That being said, i tend to manage the glucose of my patients relatively tight. 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. Sliding scale insulintime to stop sliding diabetes. Use of a standardized protocol to decrease medication errors. 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. Consider using a basalbolus and supplemental correction insulin regimen. Sliding scale insulintime to stop sliding diabetes jama. Slidingscale insulin diabetes care american diabetes association. Administer 14 units subcut, notify provider, and repeat poc blood sugar check in 30 minutes.
This is done about four times a day every five to six hours, or before meals and at bedtime. Read this important information about sliding scale. If i do use a sliding scale, i want them to have a low threshold to call me. Jun 25, 2019 lantus insulin glargine, a longacting insulin is used for treating type 1 q. May 01, 2010 glycemic control in hospitalized patients who are not in intensive care remains unsatisfactory. Supplemental insulin should usually be given in addition to basal insulin and, unless a patient is fasting, bolus insulin. Basalbolus vs sliding scale insulin in the hospital rk. It is difficult to 9obtain optimal control without occasional, mild episodes of hypoglycemia.
Correction insulin sliding scale, supplemental, bolus. Some sliding scales are in the form of general charts that are used for many different patients with doses given based on the patients weight and activity level. Nsw adult subcutaneous insulin prescribing chart user guide. I frequently use long acting insulins, usually lantus, for their basal insulin requirements, and then either a supplemental if i know theyre going to eat well or a sliding scale. Click on the image or right click to open the source website in a new browser window. Communication or other orders related to regular insulin sliding scale of blood sugar monitoring. Nov 26, 2014 insulin therapy in the management of diabetes 1. These images are a random sampling from a bing search on the term insulin sliding scale. Clinical outcomes associated with use of subcutaneous. Continue to repeat 10 units subcut and poc blood sugar checks every 1 hour until blood glucose is less than 300 mgdl, then resume normal poc blood sugar check and insulin regular sliding scale. 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. 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. Sliding scale insulin is when the prescriber orders a specific amount of insulin to be given based on a capillary blood glucose level cbg. Basaglar insulin glargine injection 100 unitsml has no dosing differences with lantus insulin glargine injection 100 unitsml for insulin initiation 1,5.
Registered nurses can delegate a wide range of tasks, including slidingscale insulin. If insulin is still required after 7 days a new chart should be written. This required practitioners to measure u500 doses with a u100 syringe or tuberculin syringe, and to teach the patient how to communicate their doses in syringe units. Patients in a mixed medicalsurgical icu were compared during two 9 month periods. The more experienced resident explains how to prescribe regular insulin every 4 to 6 hours without any scheduled basal or. Aftermeal blood glucose closer to goals there is a higher risk of low blood glucose if meals are delayed. Administer 14 units subcut, notify provider, and repeat poc blood sugar check in 1 hour. Feb 06, 2018 supplemental insulin may be given according to a sliding scale, or as oneoff stat doses. Ags beers criteria pocket pamphlet eradicating insulin. The sliding scale group was treated using ad hoc sliding scale infusion therapy. Intensifications of scheduled and sliding scale insulin, but not oral medications, were associated with a 11. The more experienced resident explains how to prescribe regular insulin every 4.
Canadian agency for drugs and technologies in health 600865 carling avenue, ottawa, ontario, 1s 5s8. Insulin, sliding scale insulin regimens containing only short or rapidacting insulin dosed according to current blood gluclose levels without concurrent use of basal or longacting insulin avoid higher risk of hypoglycemia without improvement in hyperglycemia management regardless of care setting. Correctional insulin supplemental or sliding scale needs to be adjusted to the patients insulin sensitivity and should be given with meals if eating or q46h if fasting, starting at blood sugars 150 mgdl 8. Some people also take it if blood sugars are high at bedtime. Student needs assistance from caregiver with drawing up and checking insulin dose but administers injection independently. Fluids potassium and regular insulin therapy must be prescribed on the. Glycemic control in hospitalized patients not in intensive. 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. Despite persistent expert recommendations urging its abandonment, the use of sliding scale insulin. For slidingscale insulin, a resident who is stable may only require general supervision, whereas, a resident who is unstable getting. Guide to starting and adjusting insulin for type 2 diabetes. Pdf slidingscale and basalbolus insulin regimens are two options available for the treatment of severe or acute hyperglycemia in type 2. There is space for up to 3 different types of insulin to be prescribed most patients however are on 1 or 2 types of insulin and up to 4 doses a day as needed.
Find out how it works and learn about problems with this diabetes. Jan 31, 2020 lantus insulin glargine, a longacting insulin is used for treating type 1 q. Sliding scales are less effective in covering a premeal high blood sugar, because the high blood glucose correction and food bolus cannot be split. Sliding scale fees i believe money should never stand in the way of good therapy.
Apr 08, 2019 humalog sliding scale pdf sliding scale therapy approximates daily insulin requirements. Humalog sliding scale pdf sliding scale therapy approximates daily insulin requirements. Diabetes mellitus is a metabolic disorder resulting from a defect in insulin secretion, function, or both. Sliding scale insulin adult sheet palliative prns k. Historically, sliding scale regular insulin was the issue now rapid acting insulins are a concern. Jul 18, 2019 lantus sliding scale pdf in slidingscale insulin therapy, the dose is based on your blood sugar level. Mar 31, 2018 full text is available as a scanned copy of the original print version. Administer 12 units subcut, notify provider, and repeat poc blood sugar check in 1 hour. Although the actual form is the same, requirement and attachments for each category is different. Links to pubmed are also available for selected references. I also believe that my clients are adults and are well aware of what they can afford to pay. Educational tools eradicating insulin sliding scales. Slidingscale regular insulin ssi in the management of. A diabetic manual for the mutual use of doctor and.
Mashfiqul hasan phase b resident department of endocrinology bsmmu 2. Dont use sliding scale insulin ssi for longterm diabetes management for individuals residing in the nursing home. Chapter 21 adjusting the insulin dosage and thinking scales hours, the evening nph or lantus given at it is important to emphasize that sliding. Insulin drug chart for nursing printable sliding scale.
A nomogram for intravenous insulin infusion in critically ill patients was evaluated in a retrospective beforeafter cohort study. Use of a standardized protocol to decrease medication. Sep 25, 2019 humalog sliding scale pdf sliding scale therapy approximates daily insulin requirements. In most teaching hospitals in the united states, primary care firstyear residents and medical students learn about sliding scale insulin ssi, usually from a senior resident. The amount of carbohydrate to be eaten at each meal is preset. Apr 05, 2020 lantus insulin glargine, a longacting insulin is used for treating type 1 q. Sliding scale regular or humalog insulin uw health. Insulin management guidelines emergency care institute. Insulin inservice atc healthcare service medical staffing. Sliding scale insulin is generally defined as a set of instructions for administering insulin dosages based on specific blood glucose readings. Pdf slidingscale versus basalbolus insulin in the management. The overwhelming majority of the patients ive encountered on the wards have diabetes mellitus dm. Insulin sliding scale, correctional insulin dosing. Nursing accessories id badge holders clothing info.
While there are countless ways to manage dm as an outpatient insulin injections, biguanides, sulfonylureas, etc. In slidingscale insulin therapy, the dose is based on your blood sugar level. The general principles of sliding scale therapy are. Standardisation of an adult subcutaneous insulin prescribing chart provides a common tool for consistent communication, documentation, interpretation and administration of insulin orders across nsw. Typically, the issue that arises is the level of supervision that is required when a registered nurse delegates activities. Hyperglycaemia in noncritically ill hospitalised people is associated with poor clinical outcomes infections, prolonged hospital stay, poor wound healing, higher morbidity and mortality. Ssi has been used as the standard practice for diabetic patients since. Cbg testing, for sliding scale insulin, is done prior to administering insulin. Jan 14, 2009 in most teaching hospitals in the united states, primary care firstyear residents and medical students learn about sliding scale insulin ssi, usually from a senior resident.
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. Insulin sliding scale dose blood sugar low dose moderate dose high dose. Refer to procedure for injectable insulin administration refer to procedure for insulin pen administration partially independent. Blood glucose level target blood glucosecorrection factor units insulin to be given example. The chart accommodates 7 days of therapy and the dates run down the page. Lantus insulin glargine, a longacting insulin is used for treating type 1 q. Correction insulin corrects or lowers high blood sugars before meals. Insulin therapy in the outpatient setting american college of. The sliding scale method does not accommodate changes in insulin needs related to snacks or to stress and activity. In other words, a sliding scale alone is usually not sufficient, an exception being some type 2 diabetics on low insulin doses. These are my suggestions for what you might pay depending on family income and size.
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