When is sliding scale used

Long-acting insulin : One dose each day. For this method to be effective, the person must take their meals at the same time each day, or unwanted fluctuations in blood glucose may result. Alternatively, the person may use an insulin pen to inject insulin. The pens are adjustable, to allow for different doses. Find out more about insulin pens in our dedicated article here.

The person must make daily calculations to keep their glucose levels as close to their target level as they can. Intensive insulin therapy compensates in real-time for factors that may affect blood glucose levels and insulin sensitivity. Basal insulin : This is a long-acting insulin that a person takes once or twice a day. Nutritional insulin : This is a mealtime dose, which the person calculates according to the number of carbohydrates the meal will contain.

To calculate the dose, the person should divide the number of grams of carb in the meal by the grams of carbs that one unit of insulin breaks down. Correctional insulin : To form a complete mealtime dose, the person will need to combine a correctional insulin value with the nutritional insulin value.

This may be necessary if a person has high blood glucose levels before a meal. To calculate this dose, the person will work out the difference between their target glucose level and their current level, in other words, how much extra glucose is currently present. Then, they will take enough insulin to process the excess glucose. A correction dose can also redress the insulin balance if a person does extra exercise or any other factors that might increase the sensitivity of or need for insulin.

Intensive insulin therapy is effective if a person follows it correctly, but it can be hard to use. Many people who need insulin now use an insulin pump. It works on a similar principle to basal-bolus insulin, but it removes the need for regular injections. The pump is a small, digital device that provides a steady supply of insulin throughout the day basal , with an extra dose around mealtimes bolus.

The person will wear the pump on their body. The insulin travels from the pump, through a small tube and needle, into the body. The individual will need to work with their doctor to program the pump and to work out which doses they need. They may still need to inject insulin at mealtimes or after exercising. They will also still need to check blood glucose levels regularly, as with other methods of insulin therapy. Good blood sugar management can prevent complications from developing, and can help people to live a healthier and longer life.

Doctors no longer recommend using a sliding scale, but there are several other options to choose from. Insulin helps the body use glucose to produce energy. Insulin resistance occurs when excess sugar circulates in the body. Over time, it can lead to….

A protein tied to the development of anxiety has now also been linked to the onset of type 2 diabetes. Although a complete discourse on the determination of the appropriate starting dose of insulin is outside of the scope of this cas presentation, the basic approach begins with calculating a weight-based total daily dose of insulin, approximately half of which can be given as basal insulin with the remainder given with meals along with correctional insulin as needed to account for premeal hyperglycemia.

The Society of Hospital Medicine has formulated an online subcutaneous insulin order implementation guideline, eQUIPS, that can be a helpful resource to centers that are interested in changing their practice patterns. In the case presentation, the hyperglycemic patient whose metformin was on hold should have been started on a combination of basal and prandial insulin as determined by his weight and current renal function as opposed to monotherapy with SSI. Using SSI as monotherapy for hyperglycemia is a common practice, and although well-intentioned, it is an ineffective and possibly dangerous approach.

Continued efforts must be made to address the gap between guidelines and suboptimal practice patterns locally and nationally. Do you think this is a low-value practice? The authors would like to thank Dr. Skip to main content. Published online first November 28, Hospital Medicine. J Hosp Med. Glycemic control in medical inpatients with type 2 diabetes mellitus receiving sliding scale insulin regimens versus routine dia.

Ann Fam Med. Current Issue. Menu Close. Sometimes it can cause blood sugar to dip too low. That may be why studies have found that people using this method often have longer hospital stays than if they were given fixed insulin doses. Personal factors include:.

If you received a rapid-acting dose of insulin with lunch, it may have brought your blood glucose within its target range. But this may lead to too little insulin being used for your next meal. Sometimes the doses are given too close together or stacked, which causes their effects to overlap.

Instead, they recommend using basal insulin , with mealtime insulin added as needed. Basal insulin involves long-acting insulin injections that help keep insulin levels steady throughout the day. Added to this are rapid-acting mealtime insulin and correction doses to regulate blood sugar levels after meals.

Some experts say that sliding-scale insulin therapy should be phased out completely. But one report from the American Diabetes Association says more research still needs to be done. The report calls for more studies to compare sliding-scale insulin with other insulin regimens before doctors make the final verdict.

Read on to learn how your insulin needs may…. Has taking insulin led to weight gain for you? Learn why this happens, plus how you can manage your weight once you've started insulin treatment. Mealtime insulins are fast-acting insulins that are taken immediately before or after meals. Read on to learn more about mealtime insulin, including…. The risk factors for type 2 diabetes are complex and range from genetic to environmental to lifestyle choices.