It depends, is you sliding scale in addition to a programed insulin like lantus or an oral agent or is it the only hypoglycemic agent being used. Sliding scale insulin refers to a treatment regimen that provides no. Premixed insulin can be helpful for people who have trouble drawing up insulin out of two bottles and reading the correct directions and dosages. Change from basal insulin to insulin detemir can be done on a unittounit basis then adjust to achieve glycemic targets. Default administration times can be adjusted as required, by clicking the frequency drop down arrow, and then clicking the ellipsis button. Lantus glargine or levemir detemir or nph insulin a1c greater than 7% with optimal long acting basal insulin. Cat is currently on lantus will be home friday from shelter will do detox and then need a dosing scale using human glucometer.
Most doctors prescribe a long acting insulin such as lantus to be taken daily and then also a shorter acting insulin to be used on a sliding scale. When using a sliding scale, eat the same amount of carbohydrate at each meal. This guideline is for intravenous sliding scale insulin, it is to be used in conjunction with the new 2 day intravenous sliding scale insulin prescription chart. First described in 1934, what physicians typically refer to as sliding scale insulin ssi is fast or rapidacting insulin only, given subcutaneously, typically at meal times and sometimes bedtime, but only when blood glucose is above a threshold e. Lantus insulin glargine is a brandname prescription medication. I often wonder how much of an adjustment two units of lantus is. Stepwise dosing and titration of insulin for type 2. Includes the analogues glargine u100 and detemir, each of which begins working. Insulin dose calculation sliding scale diabetestalk. Product monograph lantus insulin glargine injection. Intensive insulin therapy diabetes education online. It will not work as intended, and you may lose blood sugar control. I use 810 units, and each waking reading is different, sometimes with hypo episodes with a dose that left me in the 110. Lantus compared with sliding scale insulin in patients who had bariatric.
Lantus lantus sliding scale pdf in slidingscale insulin therapy, the dose is based on your blood sugar level. A basalprandial dosing option for nonintensive care. The amount of insulin to correct a blood glucose level above the students target range. If changing patients from oncedaily nph insulin to oncedaily lantus, the recommended initial lantus dose is the same as the dose of nph that is being discontinued. Please practice handwashing and social distancing, and check out our resources for adapting to these times. Lantus glargine or levemir detemir or nph insulin a1c greater than 8% on 2 or 3. Glargine after cardiac surgery using percentagebased versus. Learn sliding scale insulin with free interactive flashcards. Umc health system patient label here sliding scale insulin regular 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. Mealtime insulin management what is mealtime insulin. Pull back on the syringe plunger again to draw your correct dose.
Most doctors advise against the sliding scale approach. You may need to learn how to use a sliding scale plan, or an insulintocarbohydrate ratio, to figure out your dose. It is also useful for those who have poor eyesight or dexterity and is convenient for people whose diabetes has been stabilized on this combination. Tap gently on the measuring scale of the syringe to move any bubbles to the top of the syringe near the needle. While im very much locked in on an insulintocarbohydrate ratio with my novolog, its a bit tricky to judge how much the longerlasting insulins affect your blood glucose. It is for most folks a 24 hour insulin dose and is not to be used to bring down an elevated bg in a short time period. Eliminate traditional monotherapy sliding scale dosing.
The default dosing range sliding scale in order comments can be adjusted as required. Medication errors with the dosing of insulin patient safety authority. Administer 12 units subcut, notify provider, and repeat poc blood sugar check in 30 minutes. Rotate the sides right, left of your body where you inject within. Insulin pens appear similar to one another despite containing different insulins basal or bolus read each syringe carefully and note its color prior to each injection to prevent overdose errors. Oral agents for diabetes were held upon admission and patients were followed throughout their hospital stay.
Do not mix or dilute lantus with any other insulin or solution. Sliding scale insulin use has become controversial in recent years because it treats hyperglycemia after it has occurred and it can cause dangerous fluctuations in blood glucose levels throughout the day. As a medical practitioner, you have to take the national council licensure examination before you are allowed to practice. Administer 14 units subcut, notify provider, and repeat poc blood sugar check in 30 minutes. Sliding scale insulin ssi is not an effective way of managing longterm. Insulin pens are supplied in boxes of 5 pens each containing 3 ml at 100 units insulin per ml. The person tests their blood sugar before each meal and at bed time and compares the result to the scale prescribed by the doctor and inject the appropriate amount of insulin if indicated. Clinical judgment should always be used as the suggestions may not apply to every patient. Your lantus dose should be about 40% 50% of your total daily dose of insulin. Sliding scale insulin does not take into account basal insulin needs, diet type and amount, and personal.
Use lantus solostar prefilled pen with caution in patients with visual impairment who may rely on audible clicks to dial their dose. I took units of lantus yesterday and my blood glucose was 86 mgdl before lunch. Sliding scale regimens may include a bedtime high blood sugar correction. The solution is in a 10 ml vial that has 100 units of insulin glargine per ml. Based on weight or total daily insulin requirement ahrq 2012 sliding scale refers to a set amount of insulin administered for hyperglycemia without regard to the timing of food, presence or absence of preexisting. Discussion in lantus basaglar glargine and levemir detemir started by cbiscuit, nov 12, 2015. Copies of all pdf documents and tocs are sent by email. Roll the vial of insulin suspension between the palms prior to drawing up the medication. Sliding scale coverage usually begins after blood glucose 11 mmoll 200 mgdl if coverage is needed q4hr for 24 hr, then base insulin dose is adjusted first. Find out how it works and learn about problems with this. Lantus sliding scale pdf in sliding scale insulin therapy, the dose is based on your blood sugar level.
Ive been taking lantus at bedtime for about a month and i never seem to get any type of consistent morning blood sugar reading with the same dose. Hello all, do any of you use a sliding scale for lantus dosing at bedtime. Draw air into the syringe equal to your insulin dose. Do not draw correction dose into same syringe as premixed insulin. For correction scale sliding scale insulin, record the blood glucose reading obtained before insulin administration. Lantus insulin glargine, a longacting insulin is used for treating type 1 q. The lantus solostar prefilled pen dials in 1unit increments. It may be stated as a stepwise correction or sliding scale or may need to be calculated by a formula to determine dose. 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. Umc health system patient label here sliding scale insulin. Glycemic control with regular versus lispro insulin. Premixed insulin can be helpful for people who have trouble drawing up insulin out of two bottles and. Chapter 21 adjusting the insulin dosage and thinking scales hours, the evening nph or lantus given at it is important to emphasize that sliding. Lantusinsulin glargine injection rdna origin is a recombinant human insulin analogue.
Using sliding scale to determine insulin dose youtube. Oct 7, 2014 insulin drug chart for nursing printable sliding scale insulin chart. You need to talk with your doctor or see a specialist who deals with diabetes. 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. As the nighttime scale only considers the amount of insulin required to drop your blood sugar level back into the target range, it should not be used to cover a bedtime snack. Insulin drug chart for nursing printable sliding scale. Lantus is not an insulin that you would use a sliding scale or an evening bg reading to help dose. 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 scale insulin ssi is not an effective way of managing long term. Find out how it works and learn about problems with this diabetes.
Dosing lantus insulin glargine injection 100 unitsml. Get the recommended starting dose or use the dosing calculator for. Learn about the options for how to start appropriate t1dm and t2dm patients on lantus. Can lantus be used as a sliding scale with my current insulin of. The following are suggestions for insulin initiation and titration. How the sliding scale works the sliding scale is actually a chart of insulin dosages. If changing patients from twicedaily nph insulin to oncedaily lantus, the recommended initial lantus dosage is 80% of the total nph dose that is being discontinued. The idealised diagram shows the fluctuation of blood sugar red and the. They are usually injected about 10 minutes before mealtime. If all you are holding is the bolus dose of insulin but mantaining the blood sugar on other agents 200 seems a bit high but not completely nuts for a. Should insulin be withheld when nothing by mouth is. Should be customized to match insulin sensitivity for each patient. Unstable insulin levels are hazardous to patients, potentially making them hypoglycemic, especially in the morning after taking their.
In fact, the american diabetes association have pushed for this treatment method to no longer be used. Lantus insulin glargine rdna origin injection, 100 uml fda. Once again, this will vary from student to student. Errors and poor outcomes with sliding scale insulin dosing. Usual doses are small, as they begin working quickly and the patient receives the benefit of the full dose immediately. Insulin is a protein hormone that is used as a medication to treat high blood glucose. Lantus should be administered once a day at the same time every day. Doctors give trusted answers on uses, effects, sideeffects, and cautions. Optimizing glucose management in hospitalized patients. Lantus basalpr egimen indications and usage for lantus lantus is a longacting insulin analog indicated to improve glycemic control in adults and children 6 years and older with type 1 diabetes mellitus and in adults with type 2 diabetes mellitus. Fortythree patients with type 2 diabetes, who were taking oral agents only, were admitted to a medical inpatient service and randomized to receive either regular or lispro insulin sliding scale. Lantus is actually best when given at the same dose both morning and evening, not using a sliding scale there are other insulins that use the sliding scale but we know of another group that advocates the use of a sliding scale with lantus that they. After you decide on a certain order for drawing up your insulin, you should use the same order each time. The sliding scale is one way of working out how much insulin to take before each meal.
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