Endocrinology Book

http://www.fpnotebook.com/

Insulin Sliding Scale

Aka: Insulin Sliding Scale, Correctional Insulin Dosing
  1. General
    1. Use this sliding scale as an example only
    2. Adjust per patient weight and activity or Disability
      1. Type I Diabetes Mellitus = 0.6 - 0.7 u/kg/d
      2. Type II Diabetes Mellitus = 0.3 u/Kg/d
  2. Disadvantages: Sliding Scale Insulin
    1. Reactive approach to Blood Sugar control
      1. Delays Insulin until Hyperglycemia appears
    2. Does not meet basal Insulin requirements
    3. Promotes large swings in Glucose control
  3. Protocol: Summary
    1. Cover as units per Glucose 50 mg/dl over 150 mg/dl
    2. Adjust per condition
      1. Lower doses
        1. Low weight patient with Type I Diabetes Mellitus
        2. Renal Failure (Insulin 50% renal excreted)
      2. Higher dose
        1. Large patient with Type II Diabetes Mellitus
        2. Corticosteroid use
        3. Sepsis or severe illness
  4. Protocol 1: Based on Insulin sensitivity
    1. Basal Insulin should not be eliminated
      1. Applies even to those not eating
      2. Lantus should be continued at usual dose
      3. NPH Insulin
        1. AM dose: 50% of usual dose
        2. PM dose: 100% of usual dose
    2. Estimate sensitivity using "rule of 1800"
      1. BG change per unit Insulin = 1800/total Insulin daily
      2. Example of 60 units/day: 1 unit drops BG 30 mg/dl
    3. Protocol (uses rapid acting Insulin, e.g. Lispro)
      1. Goal Blood Glucose is <150
      2. Using sensitivity, how many units to drop 50 mg/dl
        1. For example above, ~1 unit to drop BG 50 mg/dl
          1. BG 150-199: 1 unit Bolus Insulin (regular or RA)
          2. BG 200-249: 2 units Bolus Insulin
          3. BG 250-299: 3 units Bolus Insulin
          4. BG 300-349: 4 units Bolus Insulin
          5. BG Over 350: 5 units Bolus Insulin
        2. Add in coverage for meal intake
          1. Based on per carbohydrate when Glucose >60 mg/dl
          2. Use for Type I Diabetes, consider for Type II
          3. Add to sliding scale coverage above
          4. Add 1 unit Insulin per carbohydrate
          5. Example: For 3 carbohydrate meal, add 3 units
  5. Protocols: Sliding Scales (contact provider if maximum Glucose is exceeded)
    1. Very low schedule (Insulin-sensitive)
      1. BG 150-199: 0.5 unit Bolus Insulin (regular or rapid-acting)
      2. BG 200-249: 1 units Bolus Insulin
      3. BG 250-299: 1.5 units Bolus Insulin
      4. BG 300-349: 2 units Bolus Insulin
      5. BG Over 350: 2.5 units Bolus Insulin
    2. Low schedule
      1. BG 150-199: 1 unit Bolus Insulin (regular or rapid-acting)
      2. BG 200-249: 2 units Bolus Insulin
      3. BG 250-299: 3 units Bolus Insulin
      4. BG 300-349: 4 units Bolus Insulin
      5. BG Over 350: 5 units Bolus Insulin
    3. Medium schedule
      1. BG 150-199: 1 unit Bolus Insulin (regular or rapid-acting)
      2. BG 200-249: 3 units Bolus Insulin
      3. BG 250-299: 5 units Bolus Insulin
      4. BG 300-349: 7 units Bolus Insulin
      5. BG Over 350: 8 units Bolus Insulin
    4. High schedule (Insulin-resistant)
      1. BG 150-199: 2 unit Bolus Insulin (regular or rapid-acting)
      2. BG 200-249: 4 units Bolus Insulin
      3. BG 250-299: 7 units Bolus Insulin
      4. BG 300-349: 10 units Bolus Insulin
      5. BG Over 350: 12 units Bolus Insulin
  6. References
    1. Schnipper (2009) J Hosp Med 4(1): 16-27 [PubMed]

Sliding scale insulin regime (C0557977)

Concepts Therapeutic or Preventive Procedure (T061)
SnomedCT 225301004
Spanish esquema de insulina con escala variable (régimen/tratamiento), esquema de insulina con escala variable (régimen/terapia), Sliding scale insulin regime, Sliding scale insulin regime (regime/therapy), esquema de insulina con escala variable
English Sliding scale insulin regime, Sliding scale insulin regime (regime/therapy), Sliding scale insulin regime (procedure)
Sources
Derived from the NIH UMLS (Unified Medical Language System)


You are currently viewing the original 'fpnotebook.com\legacy' version of this website. Internet Explorer 8.0 and older will automatically be redirected to this legacy version.

If you are using a modern web browser, you may instead navigate to the newer desktop version of fpnotebook. Another, mobile version is also available which should function on both newer and older web browsers.

Please Contact Me as you run across problems with any of these versions on the website.

Navigation Tree