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Insulin sliding scale is a perfect diabetes treatment?
Insulin therapy tries to stabilize a patient's serum glucose levels with
respect to future carbohydrate intake, rather than retrospectively
treating a rise in serum glucose. Using an insulin sliding scale to
arrange a high glucose level creates a greater risk of peaks and valleys
in the patient's serum glucose, so it should not be the sole form of
insulin therapy. Although, you can use a sliding scale dose to bring
down a lofty glucose level, it may not do so for several hours and it
may augment the risk of hypoglycemia. For further details, read Tips
For Diabetes Care.
The insulin requirements
of type 1 diabetes and type ii diabetes are different. Type 1 patients
require less insulin than diabetes type 2. They need basal insulin to
prevent DKA and extra insulin with each meal. If patients are
carbohydrate counting, allow patients to help determine meal insulin
bolus. Again, this scale is not intended for bedtime insulin coverage or
patients that are not eating. You can create a sliding scale for type 2
diabetics as well with NPH at bedtime and regular or lispro insulin
sliding scale before meals. But, you may need to decrease doses in renal
failure (insulin is not as rapidly cleared). You may also need to
increase doses for patients who are septic or treated with steroids
(insulin resistance).
To make relevant and effective insulin dose
adjustments, focus on blood glucose trends and recognize patterns during
the first 2 days of the patient's hospitalization. Once you have
identified trends, you can adjust future insulin doses for tighter
glycemic control. The American Diabetes Association recommends that a
patient's blood glucose level be less than 180 mg/dl, 2 hours after a
meal. The cornerstone of insulin therapy should be an intermediate or
long-acting insulin, accompanied by a rapid-acting insulin for meal
coverage.
Use the sliding scale only as a supplement to correct
acute hyperglycemia. In my view, the major deficit of sliding scale
insulin is that it allows to leave the patient’s diabetes management in
the hands of floor nursing staff or others. This is a prescription for
hypoglycemia.
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