help!!! insulin sliding scale

krisiepoo · Dec 19, 2013

In the medical orders, the MD will write something like "if BGL less than 140, no insulin... 140-150 give 2 units... 151-160 give 3 units" or something similar, depends on the person, depends on the doctor...

essentially give a different amt of insulin based on what their BGLs are

Esme12, ASN, BSN, RN · Dec 19, 2013

On my next test we will have to calculate insulin on a sliding scale... Can someone please explain. To me how.. For some reason I'm confused

How do you mean? They will supply the scale and you decide what to cover and with how much?

RainMom · Dec 19, 2013

A sliding scale is simply a chart of blood glucose values with corresponding doses of insulin to guide the nurse for treatment. For example at my facility, a typical scale is:

CBG 151-175 : 2 units Humalog

CBG 176-200 : 4 units

CBG 201-250 : 6 units

& so forth

So if your pt's CBG is 165, you treat with 2 units; CBG 212 - 6 units; CBG 138 - no insulin.

The scale is not always the same for every pt. Some start with higher doses (4-6 units at CBG 151) or don't treat until CBG is higher (200). The sliding scale to follow is given as a guideline in the MAR.

I imagine for testing, you will be given a sliding scale, your pt's CBG & asked what dose of insulin you will give. It's just a matter of matching the CBG result with the corresponding dose.

MendedHeart · Dec 19, 2013

You may also, more commonly in the hospital, see sluding scale orders as a formula.

For example:

Order:

Blood Sugar-140/30

The 140 could be any number. It is what the MD want the pts sugar. The 30 in sensitivity factor provided by MD based on BMI and such

CDEWannaBe · Dec 19, 2013

I can't believe they're still teaching sliding scale! That was old fashioned 20 years ago.

If you need it for your test, do what others above have explained. Most diabetics now use a corrections factor and carbohydrate factor to calculate insulin dose. These methods are used to dose short acting insulin only. The long acting insulin remains the same day after day.

Correction factor is the amount glucose is lowered by 1 unit of insulin. It differs for each person, but a starting point is often 30 points. So if target glucose is 100 and current reading is 160, 2 units of insulin are needed (160-100 = 60, then 60/30= 2 units)

Carbohyrate factor is the number of carbohydrates covered by 1 unit of insulin. It differs for each person too, but a common starting point is 1unit for every 30 grams of carb. So if a meal has 90 grams of carb, then 3 units of insulin would be added to the mealtime short-acting insulin dose.

tsm007 · Dec 19, 2013

I can't believe they're still teaching sliding scale! That was old fashioned 20 years ago.
If you need it for your test, do what others above have explained. Most diabetics now use a corrections factor and carbohydrate factor to calculate insulin dose. These methods are used to dose short acting insulin only. The long acting insulin remains the same day after day.
Correction factor is the amount glucose is lowered by 1 unit of insulin. It differs for each person, but a starting point is often 30 points. So if target glucose is 100 and current reading is 160, 2 units of insulin are needed (160-100 = 60, then 60/30= 2 units)
Carbohyrate factor is the number of carbohydrates covered by 1 unit of insulin. It differs for each person too, but a common starting point is 1unit for every 30 grams of carb. So if a meal has 90 grams of carb, then 3 units of insulin would be added to the mealtime short-acting insulin dose.

I'm still a student, but both hospitals I have been to thus far still use sliding scales. I have personal experience with carb factor and correction factor, but I haven't actually seen anyone use it in the hospital. In fact, most nurses looked at me like I had 3 eyeballs when I asked them about it at my first rotation.

To the OP, one thing I was going to add to the thread is make sure that you do not let long acting/basal insulin rates confuse the sliding scale questions. Sometimes they will throw in something like Your patient is scheduled to have 6 units of Lantus at 7am and the patient's blood sugar is 262 and then list the sliding scale for the short acting insulin. The sliding scale is only for the short acting insulin so in that question there would be two different insulins given short and long acting insulin. My school liked to throw long acting insulin info in there to throw people off. In the hospital a lot of the patients I saw only took short acting insulin with a sliding scale, but there were some that had a long acting insulin and a short acting insulin. The sliding scale only pertains to the short acting insulin.

MendedHeart · Dec 19, 2013

They still call the correction formulas "sliding scale"

elkpark · Dec 20, 2013

I can't believe they're still teaching sliding scale! That was old fashioned 20 years ago.

I work in one of the top academic medical centers in the US, and sliding scale insulin is used widely throughout the medical center. There are standardized "low," "medium" and "high" scales and the physicians just order which scale they want for the individual client.

SHGR, MSN, RN, CNS · Dec 20, 2013

These are based on how insulin-sensitive the patient is. What CDEwannabe is describing is the way a person with type 1 diabetes would manage on a day to day basis. In the hospital you will see a variety of people with a range of sensitivity to insulin. We have people in our practice who use 300 units a day or more because of extreme insulin resistance (and "mixed" people with T1 who have gained weight and developed T2 also).

What the OP is will be asked is probably along the lines of what krisiepoo and nu rn are talking about, where the test question will give a range and the student will have to figure out what the dose will be. This is still unfortunately used in home care and correctional settings (at least in my Midwestern region), and if a patient has an old-fashioned doc.

Or, as others have said, a correction factor, like the patient's base dose of mealtime insulin is 10 units and if BG is 125-150 add 1 unit, 151-175 add two units, etc.

**(bonus if the correction factor/sliding scale goes up to like 350 so the patient hits 350 every day and the provider never gets a call).

Kuriin, BSN, RN · Dec 20, 2013

Also, depending on the person, there can be insulin given before every meal AND the additional sliding scale. So, there could be an order for 2 units of insulin and depending on the glucose, there could be no extra units up to 7. After that, for the hospitals I've done my rotation, you notify the physician. ;p

classicdame, MSN, EdD · Dec 24, 2013

sliding scale used to pertain to regular insulin only. Now we have the rapid acting insulins that help prevent, rather than treat, hyperglycemia. The American Diabetes Asso. has recommendations for inpatients, for out patients, for new-to-insulin patients, etc. There are other recommendations for cardiac patients, renal patients---no one size fits all. But to answer OP, the scale is prescribed by the MD. The nurse is only responsible for making sure the medication is administered according to orders. I would study the action and peak times of the various types. You need to know that regular insulin doses may be 10 times greater than rapid acting dose. MAY be.