Thread: Sliding scale for insulin therapy

Does anyone know what exactly the sliding-scale for insulin therapy in diabetes is? When should we use it, what exactly is it?

What is sliding scale insulin therapy?
Sliding scale can be defined as a set of instructions for adjusting the dose of insulin in accordance with the results of your blood glucose levels. This is typically used in hospitalized patients to control their blood glucose.

For example, a sliding scale order may look like -

• 2 units - if blood glucose is less than 180 mg/dL
• 4 units - if blood glucose is 181-240 mg/dL
• 6 units - if blood glucose is 241-320 mg/dL
• 8 units - if blood glucose is 321-400 mg/dL
• 10 units - if blood glucose is more than 400 mg/dL

In a typical sliding scale therapy, oral anti-diabetics or intermediate acting insulin are not prescribed at all and the entire insulin dosage for the day is given in a "reactive" manner.

When should we use it?
As I wrote above it is used by some in hospitalized patients to control hyperglycemia.

Are there any disadvantages?
Superficially it seems that sliding scale makes sense - give an appropriate dose of insulin for the blood glucose level at the time of injection.

However, many studies have demonstrated that sliding scale results in poor control of blood glucose in hospitalized patients, which in turn results in poor prognosis for the illness requiring admission. This is primarily due to the wide fluctualtions that occur in glucose levels. If the patient has stroke, the recovery may be delayed, if pneumonia, mortality rates may be higher. The duration of hospital stay also is increased.

What's the alternative?
1. Intermediate acting insulin (Isophane or NPH insulin)
2. Oral anti-diabetic agents

Use of one of the above along with plain insulin given before each meals has shown to control the hyperglycemia better and favourably affect morbidity. These agents provide the 'basal' insulin required for stable glucose control.

Personally, whenever a patient with type 2 diabetes mellitus gets admitted with me, depending on the severity of the illness I start either NPH/isophane insulin once - twice daily (basal insulin) and give a dose of regular insulin before each major meal (prandial insulin). The hyperglycemia gets controlled much faster and better.

Use of sliding scale alone (without intermediate acting insulin/ oral drugs) is not recommended anymore.

there was a mathematical formula to calculate sliding scale insulin..do any one know it?
How should we start insulin therapy?
what type?
for hospital and/or domestic settings?
when to start insulin in a patients previously on oral anti diabetics?
what should be the step wise choice in oral anti diabetics in different patients..!
..
need help in this..!