Optimizing glucose management in hospitalized patients using. Overthecounter insulin is typically limited to regular, nph, and the 7030 mixes of nph and regular. Started in 1995, this collection now contains 6769 interlinked topic pages divided into a tree of 31 specialty books and 732 chapters. Patients will receive the fulldose of glargine insulin even if npo except for those that have gfr 140 mgdl. Intermediateacting insulin is usually the first choice for dogs, and longeracting insulin is the first choice for cats. Im just curious about the protocols for sliding scale insulin. The sliding scale method does not accommodate changes in insulin needs related to snacks or to stress and activity. A sliding scale can be used on most patients when only using one insulin type, not two as in your fathers case. Clinical guideline for the use of intravenous sliding. Many people believe that diabetes is a condition that elevates their blood sugar levels.
Intensive insulin therapy closely mimics the natural insulin production. Premeal bolus with rapid acting or regular insulin and with lantus glargine or levemir detemir or nph insulin a1c greater than 7% with optimal long acting basal insulin. Basal insulin is best starting insulin choice for most patients if fasting glucose above goal. Short or rapid acting insulin used to prevent a rise in blood glucose following meals. Short or rapid acting insulin used to treat hyperglycemia. Aimpurpose of this guideline this guideline is for the management of for the management of adult patients with diabetes mellitus requiring intravenous sliding scale insulin infusion. 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. Novolog insulin aspart dosing, indications, interactions. Canadian agency for drugs and technologies in health 600865 carling avenue, ottawa, ontario, 1s 5s8. Nph insulin humulin n insulin aspart novolog insulin aspart novolog insulin lispro humalog insulin lispro humalog usually accounts for about 5070% of total daily dose of insulin usually accounts for about 3050% of total daily dose of insulin, divided by 3 meals can be used short term less than 2448.
Jan 01, 2018 type 2 diabetes mellitus is a chronic, progressive disease characterized by multiple defects in glucose metabolism, the core of which is insulin resistance in muscle, liver, and adipocytes and. 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. Traditionally, insulin vials and syringes have been used, but insulin pen devices have recently entered the veterinary market. Development and implementation of a standardized inpatient protocol for sliding scale regular insulin sliding scale regular insulin sliding scale regular insulin ssr is frequently used for inpatient management of hyperglycemia, and is associated with a large number of medication prescribing and documentation errors and adverse events including hypoglycemia bg lt 70.
For the symptoms of high blood sugar and low blood sugar, see tables 1 and 2. Optimizing glucose management in hospitalized patients. Because of the acidic ph, insulin glargine cannot be mixed in the same syringe with other insulins. Use of a standardized protocol to decrease medication errors. A simple way to find out if a state allows overthecounter insulin is to call a pharmacy in that state. It is a reactive rather than proactive approach to managing the blood glucose concentration bg.
Diabetes medications chart, diabetes mellitus, types of diabetes, prevent diabetes, diabetes. Its only job is to correct an elevated glucose level. In this therapy model, blood sugar is taken about four times. In most ssi treatment regimens, a patients blood sugar is measured using a. Glycemic control in hospitalized patients not in intensive. Insulin, given either intravenously or subcutaneously, is the preferred regimen for effectively treating hyperglycemia in the hospital. The physician has ordered insulin lispro humalog to be given before meals per sliding scale. The 30 in novolog 7030 is shortfast acting 70 intermediateall day and novolog aspart is entirely shortfast acting. When diabetes isnt diagnosed and treated early on, it can wreak havoc on the. 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. Individualize dose based on metabolic needs, blood glucose monitoring results, and glycemic goaltotal daily insulin requirement is generally between 0. Sliding scale insulin ssi, a treatment regimen that has been around since the 1930s, is most often used in hospitals. Therefore, this patients blood glucose level is high, and they need insulin coverage prior to eating because consuming a meal will increase the blood glucose even further.
Pharmacists role in ensuring safe and effective hospital use. Related links to external sites from bing these images are a random sampling from a bing search on the term insulin sliding scale. The availability of overthecounter insulin is intended to help diabetics in a bind or emergency. Nclex practice question on insulin registered nurse rn.
Sliding scale insulin is generally defined as a set of instructions for administering insulin dosages based on specific blood glucose readings. If you have type 2 diabetes, there are two main ways to replace insulin. These earlier studies used urine glucose for sliding scale, but with demonstration of inaccuracy of urine glucose 3, blood glucose replaced urine glucose for. Sep, 20 its only job is to correct an elevated glucose level. The use of sliding scale insulin has been in question for years. Frequent postoperative hyperglycaemia in cardiac surgery patients has led to the initiation of an insulin infusion sliding scale for quality improvement. In most sliding scale insulin therapy regimens, your blood sugar is taken using a glucometer. Oct 05, 2007 hi im a nursing student and im currently doing a rotation on a orthoneuro floor. Known dose from multiple daily doses or insulin pump. Insulin for gestational and pregestational diabetes. Sliding scales are less effective in covering a premeal high blood sugar, because the high blood glucose correction and food bolus cannot be split. Type 2 diabetes mellitus is a chronic, progressive disease characterized by multiple defects in glucose metabolism, the core of which is insulin resistance in muscle, liver, and adipocytes and.
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. Clinical guideline for the use of intravenous sliding scale. Sliding scale insulin aspart protocol plan physician orders place an x in the orders column to designate orders of choice and an x in the specific order detail boxes where applicable. Goal blood glucose is insulin regular or ra bg 200249. If the premeal blood sugar is high, you take higher dose of insulin.
My patients chart said to withold insulin if chemstick reveals a glucose less than 200. May 01, 2010 in most sliding scale insulin regimens, the physician is only notified of extremes of hypoglycemia i. Slidingscale insulin regimens when administered alone were associated with a threefold higher risk treatment of type 2 diabetes mellitus in the older patient view in chinese administered immediately after a meal to better match the meal size and minimize hypoglycemia. Novolog sliding scale insulin chart insulin chart, diabetes.
Historically, sliding scale regular insulin was the issue now rapid acting insulins are a concern. Insulin is required to move sugar from the blood into the bodys cells, where it can be used for energy. Novolog mix 70 30 dosing administration lines for hcps. Apr 05, 2019 sliding scale insulin therapy involves creating and following an individual chart.
Perioperative hyperglycaemia is associated with poor outcomes in patients undergoing cardiac surgery. This is done about four times a day every five to six hours, or before meals and at bedtime. It is difficult to 9obtain optimal control without occasional, mild episodes of hypoglycemia. Full text update on insulin treatment for dogs and cats.
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 scales contact provider if maximum glucose is exceeded. Novolog 70 30 sliding scale chart best picture of chart. 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. Patient was educated on slidingscale insulin therapy as follows. However, headtohead comparisons are rare, and efficacy and safety are difficult to determine because of differing patient populations, glycemic targets, metrics for evaluation, and definitions of hypoglycemia used in the various protocols.
Slidingscale insulin therapy home health patient education. Pharmacy will adjust insulin orders for subsequent glargine basal insulin based on the following scale. The team developed a standard slidingscale order set to enhance patient care and target blood glucose concentrations of 70120 mgdl. Some sliding scales are in the form of general charts that are used for many different patients with doses given based on the patients weight and activity level. Insulin is a naturally occurring hormone produced by the pancreas. Protocoldirected insulin infusion sliding scales improve. Scheduled insulin correction insulin basal insulin. Administer 14 units subcut, notify provider, and repeat poc blood sugar check in 1 hour. Numerous insulin infusion protocols have been published. 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.
Sliding scales contact provider if maximum glucose is exceeded bg 150199. Pharmacy management of postoperative blood glucose in open. What is the sliding scale range for novolog insulin. Administer 12 units subcut, notify provider, and repeat poc blood sugar check in 30 minutes. Jan 06, 2018 insulin is a naturally occurring hormone produced by the pancreas. Insulin glargine has an acidic ph, resulting in slow absorption from the subcutaneous tissue. Sliding scale therapy diabetes education standard sliding scale insulin orders 0307 phary novolog dosing insulin aspart injection 100 u ml hypoglycemia hyperglycemia getting started on novolog mix70 30 flexpen. Stepwise dosing and titration of insulin for type 2. Feb 19, 2014 pharmacy will adjust insulin orders for subsequent glargine basal insulin based on the following scale. Aspart novolog glulisine apidra add prandial insulin to basal insulin if postmeal blood glucose levels are above goal.
These protocols are designed to be given independent of nutritional intake. So, even if the patients not eating, if you check a blood glucose level and its elevated, give correction insulin if npo give. 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. Adult sliding scale for insulin regular novolin r umc health. Correction insulin sliding scale, supplemental, bolus. Your doctor or diabetes educator will help you determine the right correction scale also called sliding scale so youll know how many units of insulin to inject in order to bring your glucose down a certain number of points.
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. Guide to starting and adjusting insulin for type 2 diabetes. Sliding scale regular humulin insulin physician order set. Highlight guidelines specific to initiating insulin therapy in type 1. Those who take rapidacting insulin will use a correction dose to lower high blood glucose levels outside of mealtime. If a patient is able and expected to eat all, give supplemental lispro insulin before each meal and at bedtime following the usual column. Once the insulin type is chosen, the best method of insulin administration should be considered. Sliding scale insulin ssi is commonly used to manage hospitalized patients with and without diabetes mellitus. The main goal in designing an insulin regimen is to mimic how the body normally releases insulin. Give supplemental insulin lispro following the sliding scale protocol 1d for blood glucose 140 mgdl.
If novolog is is ordered as the rapid acting insulin, pharmacy. Using sliding scale to determine insulin dose youtube. Order order details insulin aspart moderate dose insulin aspart sliding scale 0. 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. Designing an insulin regimen diabetes education online. Outline the differences between sliding scale insulin and basal bolus insulin. Christa frodella please send us a youtube message for more details. Sliding scale novolog bg100 for bg 140 is the amount that one unit of insulin will decrease blood glucose start at 40 to be conservative if they are on home insulin basalbolus then add up their total daily insulin dose and divide that number by 1700 to get an accurate correction factor. Insulin therapy in the outpatient setting american college of. To initiate insulin therapy with marked hyperglycemiathroughout the day, start insulin using split doses of rapidacting and intermediate acting insulin. Adult sliding scale for insulin aspart novolog umc health system. In the slidingscale method, the dose of insulin to be taken is based on your blood sugar level, just before your meal. Hi im a nursing student and im currently doing a rotation on a orthoneuro floor. Development and implementation of a standardized inpatient.
The second, referred to as conventional or sliding scale insulin therapy, more loosely approximates. In the united states, approximately 26 million people have diabetes mellitus, including 10. Insulin pens specifically designed for children and adolescents allow for 0. Consider using a basalbolus and supplemental correction insulin regimen. In this video we talk about sliding scale insulin for medical students and nursing students. Novolog is rapid acting human insulin analog indicated to improve glycemic control in adults and children with diabetes mellitus 1. Jun 01, 2009 nmmcs insulin performanceimprovement team recognized a patient safety issue with the use of three insulin sliding scales that did not adequately meet the evidencebased standard of care for diabetes. Sliding scale for novolog aspart diabetes type 2 medhelp. A normal blood sugar before meals should be 70 mgdl. Approximately 23 of the total dose is given in the morning 33% rapidacting, 66% intermediateacting and in the evening with half. Reduce the dose if npo hold if npo do not hold if npo subcutaneous insulin. Type 1 diabetes t1d is a chronic condition in which the pancreas pro. Bg change per unit insulin 1800total insulin daily.
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