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