Sliding Scale Insulin Dosage

Sliding Scale Insulin Dosage

The use of a sliding scale for insulin dosing is common in inpatient treatment of a patient with Type I diabetes. As opposed to fixed insulin dosing—which uses a predetermined dose of insulin before a meal—sliding scale insulin dosing uses the pre-meal blood glucose reading to determine how much insulin to administer. For example:

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Sliding scale insulin dosing is usually used with rapid-acting insulins, such as Lispro (Humalog) or Aspart, or short-acting insulins, such as Regular Insulin (Humalin-R). Rapid-acting insulin has an onset time of around 15 minutes and peak action time of around 60 minutes. Short-acting insulin has an onset time around 30 minutes and a peak action time around 2 to 3 hours. When administering insulin using a sliding scale, the nurse should pay close attention to the patient around the peak action time—depending on the type of insulin administered—to monitor for signs or symptoms of hypoglycemia.

The use of sliding scale insulin dosing as the sole protocol for managing a patient’s blood glucose level has faced scrutiny. Sliding scale insulin dosing only takes into account the patient’s glucose level prior to the meal, so it essentially is retrospectively attempting to address hyperglycemia from a previous meal or previous underdosage of insulin. When administering insulin in response to a high blood glucose reading prior to a meal, the hyperglycemia has already happened. Further, the rapid-acting or short-acting insulin dosage does not consider the carbohydrate and sugar in the meal the patient is about to eat.

In response to this criticism, many health system protocols consist of a fixed insulin dose to be administered to moderate the basal component and/or an insulin dose based on the nutritional value of the upcoming meal that is supplemented by a sliding scale dose of a rapid-acting insulin to be used as post-meal “correction” if hyperglycemia persists after the meal.

Sliding Scale Insulin Dosage

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