Insulin: Is there a guideline for which are preferably dosed utilizing a sliding scale?

[Guest650603]

Hope you're all doing well today. This question is geared to the non-pediatric population being prescribed medications in an outpatient setting with Type 2 DM. I'm curious about what you all have seen in your own experiences, and if there's a more solid guide to this topic out there. The way I understand it, rapid and regular insulins can be prescribed using a sliding scale. However:

1) Are rapid or regular insulins ever prescribed NOT using a sliding scale?

2) Are there certain indications for intermediate or long acting insulins to ever be prescribed using a sliding scale?

3) For mixed insulins (for instance, rapid+intermediate like Humalog Mix 75/25), it's my understanding that fixed-combination insulins were developed in order to simplify dosing, which allows for twice-daily dosing. That being said, are these insulins ever prescribed on a sliding scale?

Maybe this question is too general, but just let me know and I can clarify any specifics. The answers aren't to be used for any sort of prescribing-related matters, obviously; it's just something that I'm unclear on and am curious to hear others' experiences in seeing how insulin dosing is handled.

[Libby1987]

I see rapid acting prescribed in set doses or ranges based on the meal about to be eaten.

I never see mixed anymore so couldn't speak to that.

I never see long acting prescribed with a sliding scale but very occasionally I have seen informal dose ranges.

[ArtClassRN, ADN, RN]

You will find that insulin regimes are highly individualized.

[calivianya, BSN, RN]

I had a patient once whose orders were something like 30 units Novolog before all meals. 30 units of rapid acting insulin is a little scary to me, especially since the patient reported rarely checking his BG. So yeah, it's definitely possible to see short-acting not on a sliding scale. I imagine it was probably ordered because the patient would be noncompliant with a sliding scale, i.e. would not be checking his BG as often as he should.