Insulin Administration: Standing and Sliding Scales

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Just a quick question regarding insulin administration. I work in a LTC facility. Most patients have two orders for insulin administration: a standing order and a sliding scale order. The standing order for one of our patients is as follows: Give 8 units of humalog SC before dinner. The other order is a sliding scale that starts at 150. If hypothetically the patient's blood sugar is 89 before dinner and she eats all of her food it is my understanding that the patient would get 8 units of humalog as per the order. Is this correct? I just want to make sure that I explained this to a new hire correctly. Any feedback would be much appreciated. Thanks!

Good question! 89 is a normal range of glucose level.

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Actually, I wouldn't call the doctor on that. 89 is within normal glucose range. Maybe you could give the patient right before they go to dining room or just before tray go to patient room. Would also encourage patient to eat all of meal, drink juice etc. plus have extra juice or milk handy. Can also go back on check on patient during and after the dinner. There are various nursing interventions that you can do in this scenario without calling the MD. Plus, some of MDs might ask, why are you calling he/she for that?

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In long term care sliding scales and carb counting aren't always necessary or desirable.

Many (if not most) of my diabetic residents recieve "standing scale" (I like that term) novolog. That is, they get X number of units with each meal. Obviously, holding the dose is up to the nurses judgement. A non-symptomatic resident with a BS of 89 wouldn't worry me. And we give our novolog during meals (Yes, in the dinning room while they're eating, *gasp*) so we know wether or not they're eating. No surprises later when a resident skips a meal but already got their dose.

Some acute care nurses would be uncomfortable about all this lack of sliding scales or carb counting. I realize adjusting the dose based on current BS levels and carbs eaten would result in better glycemic control. Duh. Of course it would. But this is their home. These people do not want staff constantly poking their fingers and badgering them about how many carbs they ate.

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My friend is diabetic too, and its a type 2 so it can be controlled by Diamicron MR and Pioglitazone. IF the BS is too low

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