Insulin sliding scale

[nursemaan]

We had a discussion in our workplace about one older adult patient who gets Lantus and Novorapid plus sliding scale (if BG is higher than 9.0 mmol/L) before breakfast. Her dietician recommends holding the Novorapid until after breakfast if his BG is less than 5mmol/L. My workmates and I are debating if, for example, after breakfast, the patient's BG is 9.4mmol/L, we should administer Novorapid without the correction (since his BG was 5mmol/L pre-meal) or with the correction (since his BG hs already gone up to 9.4mmol/L after meal). I would appreciate your input on this. Thanks.

[blondy2061h, MSN, RN]

You need to get this clarified with the prescriber. Generally speaking, if sliding scale is ordered pre-meals, it should be given based on the pre-meal glucose. Does he get standing novarapid with meals in addition to the sliding scale, hence the question of timing of under 5?

[nursemaan]

Yes, he gets standing novorapid. We are awaiting clarification from the prescriber. I also think that it should be based on pre-meal BG because if we would base it on after-meal BG, the standing order plus the correction may bring his BG too low before his next meal (and insulin dosing) in about three to four hours. Thanks for your input. :)

[EllaBella1, BSN]

Potentially dumb question, but what is this scale for BG values? I've never seen it before. If my patient had a BG of 9 I would be slamming them with amps of D50, lol.

[blondy2061h, MSN, RN]

Potentially dumb question, but what is this scale for BG values? I've never seen it before. If my patient had a BG of 9 I would be slamming them with amps of D50, lol.

It's mmol/L instead of mg/dl. Most of the world uses this scale. To convert these measures to the US standard mg/dl, multiple by 18. So 9 is 162 and 5 is 90.

[EllaBella1, BSN]

Gotcha. Thanks for the conversion info! :) Makes a lot more sense, lol.