Pdf slidingscale versus basalbolus insulin in the management. Intensive insulin therapy diabetes education online. Noninsulin dependent diabetes mellitus, adultonset diabetes, type 2 diabetes mellitus noninsulin dependent. Sliding scale humalog insulin protocol humalog dose sliding scale humalog sliding scale example. Choose from 45 different sets of sliding scale insulin flashcards on quizlet. Sliding scale insulin ssi, a treatment regimen that has been around since the. Sliding scale insulin ssi, a treatment regimen that has been around since the 1930s, is most often used in hospitals. Optimizing glucose management in hospitalized patients. 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. May 21, 2015 evidencebased information on insulin sliding scale from hundreds of trustworthy sources for health and social care. If a patient is able and expected to eat all, give supplemental lispro insulin before each meal and.
Insulin, given either intravenously or subcutaneously, is the preferred regimen for effectively treating hyperglycemia in the hospital. Fluids potassium and regular insulin therapy must be. Jan 14, 2009 in most teaching hospitals in the united states, primary care firstyear residents and medical students learn about sliding scale insulin ssi, usually from a senior resident. The medical staff and nursing staff at kelowna general hospital have been using these inuslin protocols for several years.
Axe an insulin resistance diet helps you lose excess weight and regulate insulin and blood glucose levels in order to reduce your risk of developing diabetes. Pdf slidingscale and basalbolus insulin regimens are two options available for the treatment of severe. Jan 31, 2020 insulin for type 2 diabetes prospective trials have demonstrated reductions in hyperglycemic measurements, hypoglycemia, and adjusted hospital length of stay when physiologic sljding insulin protocols are used. Suggested for patients with infections or those receiving therapy with.
Initiate hypoglycemia treatment protocol htp for capillary blood glucoses insulin treatment protocols. While intensive regimens require more calculation at each meal, they allow for more flexibility in timing and in the amount of carbohydrate content in meals and. 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. These earlier studies used urine glucose for sliding scale, but with demonstration of inaccuracy of urine glucose 3, blood glucose replaced urine glucose for sliding scale in diabetic. Give supplemental insulin lispro following the sliding scale protocol 1d for blood glucose 140 mgdl. A study comparing scheduled basal bolus insulin to sliding scale insulin only showed a significantly higher percentage of patients achieving goal glucose levels in the basalbolus group than in the sliding scale only group 66 vs. Sliding scale insulin vs basalbolus insulin therapy in long. Insulin protocols for hospital management of diabetes. This report describes how one trauma center developed an interdisciplinary insulin infusion protocol. The amount of carbohydrate to be eaten at each meal is preset. Type 2 diabetes adult outpatient insulin guidelines if postmeal glucose levels 180.
Sliding scale regular humulin insulin physician order set. Use of a standardized protocol to decrease medication errors. The results from reference 6 are in line with the relatively impaired insulin sensitivity and higher insulin concentrations reported in healthy adolescents 8, 9. 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. Educational tools eradicating insulin sliding scales. The risk of hypoglycaemia was significantly reduced p pdf. Historically, sliding scale regular insulin was the issue now rapid acting insulins are a concern. The interdisciplinary diabetes patient safety committee dpsc at our tertiary care center developed a sliding scale regular insulin ssr protocol for ssi which included the following guidelines. If a patient is able and expected to eat all, give supplemental lispro insulin before each meal and at bedtime following the usual column. 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. Guidelines for inpatient diabetes management these recommendations do not take into account individual patient situations, and do not substitute for clinical judgment. A retrospective cohort study compared the glycemic control of 150 hospitalized patients with diabetes and elevated inflammatory markers who were either treated.
Revised chapter 9insulin treatment in children and. Optimizing glucose management in hospitalized patients using a. Insulin for type 2 diabetes prospective trials have demonstrated reductions in hyperglycemic measurements, hypoglycemia, and adjusted hospital length of stay when physiologic sljding insulin protocols are used. The protocol will be prechecked to make sure it is ordered for any patient who is. Administer 14 units subcut, notify provider, and repeat poc blood sugar check in 1 hour. Mixed insulin is more likely to cause hypoglycemia8,19 and generally requires a fixed meal schedule8. Sliding scale insulin therapy is one way a person with diabetes can work out how much insulin to take before a meal without causing negative effects on.
Sliding scales are less effective in covering a premeal high blood sugar, because the high blood glucose correction and food bolus cannot be split. Glycemic control with a basalbolus insulin protocol in. Inpatient management of hyperglycemia and diabetes vasudev magaji, md, ms, and jann m. 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. Stepwise dosing and titration of insulin for type 2. Management incretin mimetic symlin insulin dosing carbohydrate count in insulin dosing insulin dosing in type 2 diabetes insulin sliding scale oral hypoglycemic chromium picolinate. Protocoldirected insulin infusion sliding scales improve. There is no cure for diabetes, yet it can be dealt with as well as regulated. Optimizing glucose management in hospitalized patients using. The medical protocol is designed for a nonsurgical patient who is able to eat and who requires. This prompted a protocol revision to add cognitively impaired. 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. Initiate hypoglycemia treatment protocol htp for capillary blood glucoses sliding scale insulin monotherapy and still have 2 or more blood. Its time to abandon the sliding scale mdedge family.
Sliding scale insulin ssi which uses increases in insulin doses. Download table standard sliding scale insulin protocol for patients with diabetes mellitus from publication. A hypoglycemia treatment protocol will be automatically contained within the insulin order set. Outpatient management of diabetes uses evidencebased guidelines for management and stresses tight.
Adult sliding scale for insulin regular novolin r umc health. Started in 1995, this collection now contains 6767 interlinked topic pages divided into a tree of 31 specialty books and 732 chapters. This humalog sliding scale sliding scale assumes that unit of humalog will lower the blood. Slidingscale regular insulin ssi in the management of patients with diabetes was the standard practice as early as 1934 1 and was also used in the hyperglycemic emergency diabetic ketoacidosis 2. 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. If patient unable to do multiple daily injections, consider switching to mixed insulin instead of adding prandial insulin. Our main goal in introducing these protocols was to get away from the nearuniversal use of sliding scale regular insulin and to introduce. Observational before and after study evaluating the impact of implementation of a standardized ssi protocol and preprinted physician order form. 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. Click export csv or ris to download the entire page or use the checkboxes to select a subset of records to download. Adult sliding scale for insulin aspart novolog umc health system. Evidence for the effectiveness of slidingscale insulin is lacking after more than 40 years of use.
Diabetes resource center aace disease state resources. Stepwise dosing and titration of insulin for type 2 diabetes in the ambulatory setting update 52010. Veterinary practice guidelines 2018 aaha diabetes management guidelines for dogs and cats ellen behrend, vmd, phd, dacvim, amy holford, vmd, dacvimy, patty lathan, vmd, dacvim, renee rucinsky, dvm, dabvpy, rhonda schulman, dvm, dacvim abstract diabetes mellitus dm is a common disease en countered in canine and feline medicine. Sliding scale insulin vs basalbolus insulin therapy in. Sliding scale insulin refers to a treatment regimen that. Administer 12 units subcut, notify provider, and repeat poc blood sugar check in 30 minutes.
Where do you, insulin chart for nursing school pdf file by nursenacole, practical guide to insulin therapy in. Image result for sliding scale insulin chart dosage with. To see if you are eligible, find your family in the table below. Jan 06, 2018 insulin sliding to download full version. Apr 05, 2019 sliding scale insulin therapy is one way a person with diabetes can work out how much insulin to take before a meal without causing negative effects on the body.
Adult 4 user guide to national subcutaneous insulin form exceptions. User guide to national insulin subcutaneous order and blood glucose record. Adjust insulin dose every 3 days until bg pdf 397k citation. Among the many insulin management systems that have been developed, none has been as widely used as the sliding scale. Insulin choices, effect of insulin degludec vs insulin glargine u100 on, insulin log template overweight management. Sliding scale insulintime to stop sliding diabetes jama. Improved glycemic control is the desired outcome after the discharge of patients with diabetes.
You should discuss with your doctor whether your lantus injections are working properly. Patients treated with the basalbolus insulin regimen attained lower fasting blood glucose. The more experienced resident explains how to prescribe regular insulin every 4 to 6 hours without any scheduled basal or. Its time to abandon the sliding scale mdedge family medicine. Learn sliding scale insulin with free interactive flashcards. We aimed to determine the efficacy of a basalbolus insulin protocol in hospitalized patients with diabetes treated with glucocorticoids. Using sliding scale to determine insulin dose youtube. Standard sliding scale insulin protocol for patients with diabetes. Sliding scale regular insulin ssi in the management of patients with diabetes was the standard practice as early as 1934 1 and was also used in the hyperglycemic emergency diabetic ketoacidosis 2. 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. The sliding scale method does not accommodate changes in insulin needs related to snacks or to stress and activity.
Because at night only the amount of insulin needed to cover the snacks before going to bed. Veterinary practice guidelines 2018 aaha diabetes management. 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. 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. 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. In most teaching hospitals in the united states, primary care firstyear residents and medical students learn about sliding scale insulin ssi, usually from a senior resident. The more experienced resident explains how to prescribe regular insulin every 4. Stepwise dosing and titration of insulin for type 2 diabetes. The insulin resistance diet protocol to help prevent diabetes dr. Correction insulin sliding scale, supplemental, bolus. This is done about four times a day every five to six hours, or before meals and at bedtime. Sliding scale insulin ssi therapy remains a common means of insulin therapy in longterm care ltc for the management of type 2 diabetes mellitus, despite current recommendations not supportive of the form of therapy today.
The general principles of sliding scale therapy are. Pdf protocoldirected insulin infusion sliding scales. Adjust insulin dose every 3 days until bg sliding scale depending on sensitivity. In most ssi treatment regimens, a patients blood sugar is measured using a. Administer 10 units subcut, notify provider, and repeat. An insulin sliding scale also called an insulin algorithm simply means that the amount of shortor rapidacting insulin regular, toronto, humalog, novorapid or apidra taken before a meal is adjusted according to the blood sugar at that time. Use of a standardized protocol to decrease medication. Intensifications of scheduled and sliding scale insulin, but not oral medications, were associated with a 11. Evidencebased information on insulin sliding scale from hundreds of trustworthy sources for health and social care. Insulin infusion protocol for critical care units medscape.
Dec 31, 2017 image result for sliding scale insulin chart dosage. This form is not intended to be used for children 1. In most sliding scale insulin therapy regimens, your blood sugar is taken using a glucometer. Sliding scale insulintime to stop sliding diabetes.
1538 835 1408 188 1513 1278 718 465 1646 1543 294 1169 1648 1242 751 316 160 633 1258 100 843 800 1612 515 797 1128 64 138 7 945 1347 1186 494 593 150 701 563 331 554 1482 243 1175