Insulin Sliding Scale

Aka: Insulin Sliding Scale, Correctional Insulin Dosing

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II. General

  1. Use this sliding scale as an example only
  2. Adjust per patient weight and activity or Disability
    1. Type I Diabetes Mellitus = 0.6 - 0.7 u/kg/d
    2. Type II Diabetes Mellitus = 0.3 u/Kg/d

III. Disadvantages: Sliding Scale Insulin

  1. Reactive approach to Blood Sugar control
    1. Delays Insulin until Hyperglycemia appears
  2. Does not meet Basal insulin requirements
  3. Promotes large swings in Glucose control

IV. Protocol: Summary

  1. Cover as units per Glucose 50 mg/dl over 150 mg/dl
  2. Adjust per condition
    1. Lower doses
      1. Low weight patient with Type I Diabetes Mellitus
      2. Renal Failure (Insulin 50% renal excreted)
    2. Higher dose
      1. Large patient with Type II Diabetes Mellitus
      2. Corticosteroid use
      3. Sepsis or severe illness

V. Protocol 1: Based on Insulin sensitivity

  1. Basal insulin should not be eliminated
    1. Applies even to those not eating
    2. Lantus should be continued at usual dose
    3. NPH Insulin
      1. AM dose: 50% of usual dose
      2. PM dose: 100% of usual dose
  2. Estimate sensitivity using "rule of 1800"
    1. BG change per unit Insulin = 1800/total Insulin daily
    2. Example of 60 units/day: 1 unit drops BG 30 mg/dl
  3. Protocol (uses rapid acting Insulin, e.g. Lispro)
    1. Goal Blood Glucose is <150
    2. Using sensitivity, how many units to drop 50 mg/dl
      1. For example above, ~1 unit to drop BG 50 mg/dl
        1. BG 150-199: 1 unit Bolus Insulin (regular or RA)
        2. BG 200-249: 2 units Bolus Insulin
        3. BG 250-299: 3 units Bolus Insulin
        4. BG 300-349: 4 units Bolus Insulin
        5. BG Over 350: 5 units Bolus Insulin
      2. Add in coverage for meal intake
        1. Based on per Carbohydrate when Glucose >60 mg/dl
        2. Use for Type I Diabetes, consider for Type II
        3. Add to sliding scale coverage above
        4. Add 1 unit Insulin per Carbohydrate
        5. Example: For 3 Carbohydrate meal, add 3 units

VI. Protocols: Sliding Scales (contact provider if maximum Glucose is exceeded)

  1. Very low schedule (Insulin-sensitive)
    1. BG 150-199: 0.5 unit Bolus Insulin (regular or rapid-acting)
    2. BG 200-249: 1 units Bolus Insulin
    3. BG 250-299: 1.5 units Bolus Insulin
    4. BG 300-349: 2 units Bolus Insulin
    5. BG Over 350: 2.5 units Bolus Insulin
  2. Low schedule
    1. BG 150-199: 1 unit Bolus Insulin (regular or rapid-acting)
    2. BG 200-249: 2 units Bolus Insulin
    3. BG 250-299: 3 units Bolus Insulin
    4. BG 300-349: 4 units Bolus Insulin
    5. BG Over 350: 5 units Bolus Insulin
  3. Medium schedule
    1. BG 150-199: 1 unit Bolus Insulin (regular or rapid-acting)
    2. BG 200-249: 3 units Bolus Insulin
    3. BG 250-299: 5 units Bolus Insulin
    4. BG 300-349: 7 units Bolus Insulin
    5. BG Over 350: 8 units Bolus Insulin
  4. High schedule (Insulin-resistant)
    1. BG 150-199: 2 unit Bolus Insulin (regular or rapid-acting)
    2. BG 200-249: 4 units Bolus Insulin
    3. BG 250-299: 7 units Bolus Insulin
    4. BG 300-349: 10 units Bolus Insulin
    5. BG Over 350: 12 units Bolus Insulin

VII. References

  1. Schnipper (2009) J Hosp Med 4(1): 16-27 [PubMed]

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