Highland hospital clinical protocol perioperative glucose control. Sliding scale insulin ssi which uses increases in insulin doses with predefined. The sliding scale method does not accommodate changes in insulin needs related to snacks or to stress and activity. Insulin subcutaneous order and blood glucose record adult. Use of a standardized protocol to decrease medication errors. Insulin therapy should be initiated for treatment of persistent.
Consider insulin as initial therapy if a1c very high, such as 10. Historically, sliding scale regular insulin was the issue now rapid acting insulins are a concern. Sliding scale insulin adult sheet palliative prns k. Continue to repeat 10 units subcut and poc blood sugar checks. Feb 06, 2018 supplemental insulin may be given according to a sliding scale, or as oneoff stat doses. Evidence for the effectiveness of slidingscale insulin is lacking after.
Sliding scale regular insulin dc oral antidiabetic drugs on admission starting total daily dose tdd. This protocol is not to be used for patients in diabetic ketoacidosis dka. Nursing staff will document the administered insulin dose and bgl, and this will be recorded. In other words, a sliding scale alone is usually not sufficient, an exception being some type 2 diabetics on low insulin doses.
Give insulin glargine once daily, at the same time of the day. 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. Insulin sliding scale dose blood sugar low dose moderate dose high dose. Insulin therapy in the outpatient setting american college of. Frequent postoperative hyperglycaemia in cardiac surgery patients has led to the. When elevated blood glucose is treated in the hospital setting, a sliding scale for regular insulin given by subcutaneous injection is often used without scheduled longacting insulin. User guide to national subcutaneous insulin form exceptions. The slidingscale approach to maintaining euglycemia is considered inappropriate for a number of reasons.
Syringes and needles for pen consider use pen needles that are 31or 32 gauge and 5 mm to 8 mm. If a patient is not able to eat, give supplemental glulisine insulin every. Ucsf diabetes teaching center provides comprehensive online diabetes information including self assessment quizzes. 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. Adjust routine insulin based on supplemental insulin requirements. 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. 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. Scheduled subcutaneous insulin therapy with basal, nutritional, and. This form is not intended to be used for children 1. In many hospitals in developing countries, particularly in pakistan, a sliding scale is used to calculate the dose of insulin for the management of diabetes. The default dosing range sliding scale in order comments can be adjusted as required.
Insulin dosing worksheet sliding scale insulin to carbohydrate ratio 1 unit. Aaces diabetes resource center provides its members access to clinical practice guidelines, treatment algorithms, and other resources related to the broad spectrum of diabetes care including type 2. Glycemic control in hospitalized patients not in intensive. Optimizing insulin prescribing to improve inpatient glycemic control. Use of a standardized protocol to decrease medication errors and adverse events related to sliding scale insulin a c donihi, m m dinardo, m a devita, and m t korytkowski a c donihi, m m dinardo, m a devita, m t korytkowski, university of pittsburgh medical center, pittsburgh, pa, usa. Give supplemental insulin glulisine following the sliding scale protocol 1e for blood glucose 140 mgdl. Aaces diabetes resource center provides its members access to clinical practice guidelines, treatment algorithms, and other resources related to the broad spectrum of diabetes care including type 2 diabetes and gestational diabetes. It corrects only the blood glucose level of the previous four to six hours, without.
Sliding scale pdf sliding scale regular humulin insulin eg. Grhealth validation, adultor 989898989 opened by burrell, richard. Glycemic control in hospitalized patients not in intensive care. 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. Replace insulin vial or pen as required per specific insulin package insert. If a patient is able and expected to eat all, give supplemental glulisine insulin before each meal and at bedtime following the usual column. Guide to starting and adjusting insulin for type 2 diabetes cadth.
Default administration times can be adjusted as required, by clicking the frequency drop down arrow, and then clicking the ellipsis button. Sliding scale insulin alone is not recommended, consider basal insulin needs. The medical staff and nursing staff at kelowna general hospital have been using these inuslin protocols for several years. A total of insulinnaive patients were randomized to receive glargine and glulisine n 65 or a standard ssi protocol n 65. Insulin presence of ketones sliding scale regimen signature comments hospital number ward rates of insulin infusion unitshr sliding scale regimen 3. Episodes of glucose measurements oct 14, 2016 us pharm. 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 regular humulin insulin physician order set.
Sliding scale insulin ssi is commonly used to manage hospitalized patients with and without diabetes mellitus. Using insulintocarb ratios and correction factors a nutrition resource for living well with diabetes american diabetes association if you are using background and meal. Suggested for patients with infections or those receiving therapy with. Correction insulin sliding scale, supplemental, bolus. Hypoglycemia is often caused by a failure to adjust insulin therapy in response to a reduction in. Hypoglycemia is often caused by a failure to adjust insulin therapy in response to a. Supplemental insulin should usually be given in addition to basal insulin and, unless a patient is fasting, bolus insulin. The aims of the study were to compare the glycemic. Lantus insulin glargine, a longacting insulin is used for treating type 1 q.
Use of a standardized protocol to decrease medication. 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. Adult 4 user guide to national subcutaneous insulin form exceptions. Many people with type 2 diabetes need insulin therapy. Splitmixed both insulins provide potential basal and prandial effects. Use of a standardized protocol to decrease medication errors and. In most sliding scale insulin therapy regimens, your blood sugar is taken using a glucometer. Glucose 180mgdl inpatientglycemiccontrolconsensusstatement. Topics from diagnosis to treatment for patients and providers. The risk of hypoglycaemia was significantly reduced p protocol directed insulin infusion sliding scale is safe and improves blood glucose control when compared with the conventional practitionerdirected insulin infusion sliding scale.
Administer 14 units subcut, notify provider, and repeat poc blood sugar check in 1 hour. Administer 12 units subcut, notify provider, and repeat poc blood sugar check in 30 minutes. Glucose levels will be evaluated by finger stick testing or blood testing 2. Supplemental insulin orders valid until changed or ceased sliding scale insulin alone is not recommended, consider basal insulin needs. Hyperglycemia commonly results from reliance on only sliding scale insulin to control blood. The portland continuous intravenous insulin protocol appendix a consists of a starting intravenous insulin infusion dosage, blood glucose testing frequency requirements, insulin infusion titration and. Basal insulin is best starting insulin choice for most patients if fasting glucose above goal. Divide the total carbohydrates by the insulin to carbohydrate ratio. The unanimous opinion among the staff is that these protocols are a very effective and safe means of improving inhospital management of diabetes and also reducing the likelihood of insulin errors.
Errors and poor outcomes with sliding scale insulin dosing. Continuous intravenous insulin infusion reduces incidence. Can lantus be used as a sliding scale with my current insulin of. In the hospital, it is best to give when meal tray is in front of patient or immediately after eating if it is unclear whether the patient will eat. Insulin protocols for hospital management of diabetes.
In slidingscale insulin therapy, the dose is based on your blood sugar level. Diabetes resource center aace disease state resources. Diabetes education online diabetes teaching center at the. Find out how it works and learn about problems with this diabetes. As the number of elderly people in the united states continues to rise, an increasing proportion of older adults will develop diabetes and will need longterm or skilled care. This is done about four times a day every five to six hours, or before meals and at bedtime. Educational tools eradicating insulin sliding scales. If a patient is able and expected to eat all, give supplemental lispro insulin before each meal and at. Continuous intravenous insulin infusion reduces incidence of. Optimizing insulin prescribing to improve inpatient. Development and implementation of a standardized sliding scale insulin protocol resulted in improved blood glucose control and more efficient resource utilization. If adjusting current insulin regimen, increase corresponding dose the. Sliding scale insulin for noncritically ill hospitalised adults with diabetes mellitus. User guide to national insulin subcutaneous order and blood glucose record.
Because of the unpredictable absorption kinetics of regular insulin and the reactive nature of the efforts at glucose control, the sliding scale is unphysiological and ineffective in controlling postprandial. Started in 1995, this collection now contains 6767 interlinked topic pages divided into a tree of 31 specialty books and 732 chapters. 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. Pdf slidingscale versus basalbolus insulin in the management. Slidingscale insulin does not take into account basal insulin needs, diet type and amount, and personal characteristics e. Insulin management guidelines emergency care institute. 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. Calculate insulin dose for food add up all the carbohydrates in your meal.
Perioperative hyperglycaemia is associated with poor outcomes in patients undergoing cardiac surgery. Default administration times can be adjusted as required, by clicking the frequency drop down arrow, and then. Please indicate the time and date when the sliding scale is to start for patients undergoing labour see separate policy. Insulin infusion protocol for critical care units medscape. Mealtime bolus insulin with basal insulin coverage. Continue to repeat 10 units subcut and poc blood until blood glucose is less. This document is coded jbds 09 in the series of jbds documents. Protocoldirected insulin infusion sliding scales improve. Randomized study of basalbolus insulin therapy in the. 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. Give insulin glulisine in three equally divided doses before each meal.
Diabetes education online diabetes teaching center at. Diabetes mellitus is a metabolic disorder resulting from a defect in insulin secretion, function, or both. Although its use is not recommended, slidingscale insulin therapy is still being used widely. Sliding scales are less effective in covering a premeal high blood sugar, because the high blood glucose correction and food bolus cannot be split. Using sliding scale to determine insulin dose youtube. Administer 12 units subcut, notify provider, and repeat poc blood sugar check in 1 hour.