Question about Sliding Scale insulin

Five&Two Will Do · Jul 11, 2011

I am not exactly sure what the 100/20 means. We use a couple different SS here. If the patients CBG is 145 and his SS doesn't start until 150 or 200, then I do not give any insulin.

Grumpygs, MSN, RN · Jul 11, 2011

When in doubt - call the doctor to clarify the order.

Mommy&RN, BSN, RN · Jul 11, 2011

We had one doc that recently stop using this s/s. (thank goodness)

145-100=145

45/20 =2.5

So this order has nothing to do with the hospital protocol order, because the protocol is not what he ordered.

tyvin, BSN, RN · Jul 11, 2011

What is 100/20?

Home Health Columnist / Guide · Jul 11, 2011

see these well designed sliding scale insulin orders...only blood sugars greater than 150 would be treated.

sliding scale regular/novolog insulin protocol

sliding scale insulin order

many facilities moving to customized protocal based on patients weight, renal status, steroid usage or severity of illness.

insulin sliding scale

Mommy&RN, BSN, RN · Jul 11, 2011

What is 100/20?

The line break happened on a bad spot.

It reads. (BS-100)/20

#1ME · Aug 7, 2011

OP if you are using a sliding scale, I don't see where the confusion is. During the day a bg of 145 would warrant 3 units of insulin, and in the night, would not receive any coverage, for night time, bg less than 200 is not covered

Catch22Personified · Sep 5, 2011

I've seen the weirdest sliding scale insulin the other day for one of my patients. Has anyone ever seen a sliding scale where you actually have to give coverage at 80?

Novolog Insulin is for coverage

0-79=0 Units and call MD

80-150=2 Units

151-200=4 Units

201-250=6 Units

251-300=8 Units

301-350=10 Units

351-400=11 Units

400+=12 Units and call MD

xtxrn, ASN, RN · Sep 8, 2011

I've seen the weirdest sliding scale insulin the other day for one of my patients. Has anyone ever seen a sliding scale where you actually have to give coverage at 80?
Novolog Insulin is for coverage
0-79=0 Units and call MD
80-150=2 Units
151-200=4 Units
201-250=6 Units
251-300=8 Units
301-350=10 Units
351-400=11 Units
400+=12 Units and call MD

If these are ac & hs, then yes. With the use of fast acting insulins, it's possible to be more precise. If my ac blood sugar is 80, and I'm anticipating 4 units of carbs (60 grams) I know my blood sugar will be way too high if I don't take the sliding scale, even at 80. Add other meds/conditions, and it can get really crazy. I'm on a lot of meds, including chemo that has made my blood sugars nuts.

I take 30 units of HumaLog ac just to keep my blood sugar from getting way crazy. But that's what works for me.

That's the big thing about DM and insulin- it's all so individualized. Some kids take half-units with insulin to carb ratios of 1:45; my "normal" I:C ratio is 1:4.

Check the Accuchek records, and if the patient is getting the SS as ordered, and the blood sugars are acceptable to the doc for the patient's condition, current stressors, meds, etc- you could see just about anything :)

MunoRN, RN · Sep 18, 2011

I would assume you're not to cover a BG of less than 150, that's not particularly unusual and it's really not good practice anymore to treat a BG of less than 150. (increases mortality without any benefit).

LaurenNicoleRN · Nov 29, 2011

I work in LTACH and we have that same sliding scale. BS minus 100 divided by 20. Our policy is to not give less than 5 units. So basically, our SS doesn't start until FSBG 200 or above. Also, if there is a time the patient ever needs over 15 units, we have to call the PCP first. I had a pt once who needed 21 units but per policy I called PCP who said to only give the 15 instead. It really just depends on the policy of the facility. But before you give ANY SS insulin, best bet would be to become very familiar with policy and procedure.