Our providers started having us give scheduled insulin along with sliding scale prior to meals. The sliding scale is based on what the patient 'might' eat for the meal. The providers say this is best practice. Thoughts on this? Thank you!
I work on a cardiac telemetry unit where most of our diabetics receive a sliding scale dose where the blood glucose is tested prior to their meal; some receive both a scheduled dose and the sliding scale. It appears to work out well in terms of managing blood sugar levels. Since the patient gets a bedtime sliding scale dose, even if they don't eat, since we are treating their current pre-meal blood sugar, I've yet to see a hypoglycemic episode directly related to the sliding scale.
I would think the scheduled insulin would be for the meal and the sliding scale be for correction.
Sliding scale insulin is to cover blood glucose over a set parameter (at my hospital, it is usually 200) It has nothing to do with whether they eat or not. Most patients will either have mealtime insulin and SS insulin to cover high BG or just the SS to cover high BG.
If a blood sugar is 120 the patient gets their Lantus or Levemir, PLUS 1 unit of Novolog for each 10 gms of carbs on the meal menu, this all before the meal.
If the blood sugar is 275, they get their Lantus or Levemir, their sliding scale to cover the 275 blood sugar, PLUS 1 unit of Novolog for each 10 gms of carbs on the meal menu, this all before the meal.
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