Sliding scale correction insulin calculated units total carbohydrates g food formula carb count carb ratio food insulin calculated units or set dosedaily plan. Feb 06, 2018 supplemental insulin may be given according to a sliding scale, or as oneoff stat doses. Sliding scale regular insulin dc oral antidiabetic drugs on admission starting total daily dose tdd. Day has disclosed that she has no relevant financial relationships. Student needs assistance from caregiver with drawing up and checking insulin dose but administers injection independently. 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. Calculate insulin dose for food add up all the carbohydrates in your meal. Diabetes education online diabetes teaching center at. Default administration times can be adjusted as required, by clicking the frequency drop down arrow, and then clicking the ellipsis button. Amanatullah, md, phd department of orthopedic surgery, university of california davis medical center, sacramento, california.
Can lantus be used as a sliding scale with my current insulin of. Blood glucose level target blood glucosecorrection factor units insulin to be given example. Please indicate the time and date when the sliding scale is to start for patients undergoing labour see separate policy. The ups and downs of sliding scale insulin cristi day dnp, fnp. Basal insulin is best starting insulin choice for most patients if fasting glucose above goal. 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. Longacting insulin helps control blood glucose throughout the day, while rapidacting insulin manages levels at meal time. Student will draw up or dial appropriate dose of insulin.
Insulin management guidelines emergency care institute. The sliding scale method does not accommodate changes in insulin needs related to snacks or to stress and activity. Nph insulin has elevated risk of hypoglycemia so use with extra caution6,8,15,17. An approach to starting insulin in patients with type 2 diabetes mellitus based on american diabetes association guidelines. This is done about four times a day every five to six hours, or before meals and at bedtime. Sliding scale insulin adult sheet palliative prns k. Canadian agency for drugs and technologies in health 600865 carling avenue, ottawa, ontario, 1s 5s8.
Using sliding scale to determine insulin dose youtube. This document is coded jbds 09 in the series of jbds documents. Nursing staff will document the administered insulin dose and bgl, and this will be recorded. The default dosing range sliding scale in order comments can be adjusted as required. Must verify ltcw once a week for the first four weeks of insulin delegation the first visit must be in person.
Guide to starting and adjusting insulin for type 2 diabetes. Ucsf diabetes teaching center provides comprehensive online diabetes information including self assessment quizzes. Administer 12 units subcut, notify provider, and repeat poc blood sugar check in 30 minutes. Insulin inservice atc healthcare service medical staffing. Insulin dosing worksheet sliding scale childrens healthcare of. Consider using a basalbolus and supplemental correction insulin regimen. Insulin dosing worksheet sliding scale insulin to carbohydrate ratio 1 unit. This form is not intended to be used for children 1. Understanding community based nurse delegation 2017. Guide to starting and adjusting insulin for type 2 diabetes cadth. Sliding scale insulin is generally defined as a set of instructions for administering insulin dosages based on specific blood glucose readings. Refer to procedure for injectable insulin administration refer to procedure for insulin pen administration partially independent.
Calculate total insulin dose add the number of units needed for food to the number of units needed to correct blood sugar to get your total dose of insulin humalognovologapidra. 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. Pdf slidingscale versus basalbolus insulin in the management. Topics from diagnosis to treatment for patients and providers. Despite persistent expert recommendations urging its abandonment, the use of sliding scale insulin. User guide to national subcutaneous insulin form exceptions. Supplemental insulin should usually be given in addition to basal insulin and, unless a patient is fasting, bolus insulin. Basalbolus versus sliding scale insulin therapy in the. 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 insulin therapy consists of giving patients regular or rapidacting insulin five to 30 minutes before meals, with. Use of a standardized protocol to decrease medication errors. 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.
Two methods of insulin administration in the hospital setting are currently in use. May 01, 2010 glycemic control in hospitalized patients who are not in intensive care remains unsatisfactory. 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. Sliding scale insulin generally discouraged in favor of. How to use an insulin to carbohydrate ratio to calculate how much insulin to give for food how to use a correction factor or sliding scale to correct hyperglycemia how to calculate the total meal insulin dose objectives 5 childrens healthcare of atlanta diabetes center our goals for medical nutrition therapy for children with. Pdf slidingscale and basalbolus insulin regimens are two options available for the treatment of severe or acute hyperglycemia in type 2. Lantus insulin glargine, a longacting insulin is used for treating type 1 q. T here is a lot of anxiety in medical school regarding internship, especially surgical internship.
Find out how it works and learn about problems with this diabetes. Glycemic control in hospitalized patients not in intensive. If blood glucose levels are too high, two types of insulin may be used to improve blood glucose. Division i uses a sliding scale to match test scores and core gradepoint averages gpa. In most sliding scale insulin therapy regimens, your blood sugar is taken using a glucometer. Administer 12 units subcut, notify provider, and repeat poc blood sugar check in 1 hour. With the bg target of sliding scale insulin delivery group met this goal. Adjust routine insulin based on supplemental insulin requirements. In other words, a sliding scale alone is usually not sufficient, an exception being some type 2 diabetics on low insulin doses.
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. Diabetes education online diabetes teaching center at the. 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. Determine competency of ltcw in performing safe insulin administration drawing up the insulin in a syringe dialing the dose of insulin on the prefilled syringe administering the insulin competency. Errors and poor outcomes with sliding scale insulin dosing studies demonstrate, and experts agree, that there is little evidence for using only sliding scale insulin to control blood glucose. Historically, sliding scale regular insulin was the issue now rapid acting insulins are a concern. Guidelines for inpatient diabetes management these recommendations do not take into account individual patient situations, and do not substitute for clinical judgment. The ada suggests insulin replacement therapy with basal and rapidacting prandial basalbolus insulin when the figure 1. Supplemental insulin orders valid until changed or ceased sliding scale insulin alone is not recommended, consider basal insulin needs. It is difficult to 9obtain optimal control without occasional, mild episodes of hypoglycemia. Sliding scale insulin generally discouraged in favor of considerations for patient not eating due to sickness or preprocedure pregnancy. Educational tools eradicating insulin sliding scales.
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. Administer 14 units subcut, notify provider, and repeat poc blood sugar check in 1 hour. Purpose the purpose of this user guide is to explain how clinicians should use the national subcutaneous insulin form to take full advantage of its safety features. Mealtime insulin management what is mealtime insulin.
In brief a summary of the evidence basalbolus versus sliding. Divide the total carbohydrates by the insulin to carbohydrate ratio. By the end of the session, participants will be able to. Insulin sliding scale dose blood sugar low dose moderate dose high dose.
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