[SCRN1]

At hospitals I've worked, the sliding scales don't usually call for coverage until 150 either, unless the MD writes a different SS.

[Barbie Lou]

I am a CDE in an office,and I agree the the ACE guidelines will help keep people with prediabetes and diabetes more healthy. It does feel like the ADA is not keeping up with better care. As I work with people I try to have people use meters to experiment, like research. They will do blood sugars before and 2 hours after one meal per day to see how the body handles that food combination. If above the 140 guideline we look at how the glycemic index has affected the choice. This way help them accept ownership into their own care.
This is another subject....I also download the meter readings and we look for patterns and problem times. They really strive for the target area which is green on the computer. I really enjoy working with people with diabetes.

[Myxel67]

Originally Posted by SCRN1

At hospitals I've worked, the sliding scales don't usually call for coverage until 150 either, unless the MD writes a different SS.

Sliding scales are an abomination. Our standard also starts coverage at 151 or above. So if a pt actually has a BG less than 151, he gets no insulin at that meal, so next BG is above 200.

Internists need to update their DM mgmt skills and learn to use weight-based basal/bolus insulin for hospitalized pts. Many pts come in with decent control. Then the attending physician stops all their home DM meds and replaces it with a mild sliding scale covered with REGULAR insulin.

I spend a lot of time reviewing pt BG records and calling docs to recommend changes.

[Myxel67]

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[Myxel67]

Originally Posted by grammyr

My facility is changing our insulin protocol. Each MD has his own sliding scale and his own opinion of which insulin is best. Can anyone help with guidelines for SSI parameters and whether to use Humulog or Regular?????

According to Ariel Zisman, a well-known endocrinologist, researcher, and lecturer here, "The only place for regular insulin in a hospital is in an insulin drip.

Humalog, Novolog, and Apidra (all fast-acting insulin analogs) will give better results. Regular insulin starts working in 30 - 45 minutes so must be given at least 30 minutes before the meal. The fast acting analogs start to work much more quickly, so will have a chance to be effective even if given after pt has started eating.

Sliding scales, alone, are not sufficient--unless the MD starts his scale at 60. Otherwise, the pt gets no insulin if his BG is under the threshhold of the scale. Or, the doc could order, for example, 5 units before every meal and extra insulin from SS if BG is high.

[classicdame]

I think the confusion comes in knowing what numbers are appropriate for DIAGNOSIS and which are appropriate for MANAGEMENT. If you do not have diabetes your BS should be below 126 fasting. If you have it, it should be below 130 fasting (not much different). If you are sick your BS should be kept below 110 in order to properly heal and to prevent complications.

[Myxel67]

A normal FBG is 65 to 99. FBG of 126 or higher is diagnostic of diabetes. FBG of 100 - 125 is called prediabetes or impaired fasting glucose. This is not a normal FBG. For people with DM, the American College of Endocrinologists recommends FBG below 110. ADA recommends below 130.

In people with diabetes, the goal is to keep BG as close to normal as possible. We recommend that our pts try to maintain FBG from 70 to 120 and 2-hr postprandial BG levels of 70 to 140.

FBG is not the only criterion used to diagnose DM. Glucose intolerance is also a factor. It is possible to have a FBG < 100 and still have DM. A random BG of 200 or above is diagnostic of DM. Also BG 2 hrs post glucose challenge (OGGT), BG of 200 or above also is diagnostic of DM. Although the hemoglobin A1C is not officially used to dx DM, it is often used to gauge control or to confirm suspicions of DM.