Sliding Scale Insulin

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Hi

I'm a nursing student and I'm currently doing a rotation on a Ortho/Neuro floor. I'm just curious about the protocol's for sliding scale insulin.

My patient's chart said to withold insulin if chemstick reveals a glucose less than 200.

Is it just me or doesn't that seem a little too high to NOT give insulin? Am I missing something here?

Are sliding scale protocols different for each patient? Thanks in advance

Specializes in Med-Surg.

I agree, that's a bit outdated. There was an old idea that as long as diabetics were less than 200 that was fine. Some of the latest research advocates for more tighter control, particularly for wound healing.

I also agree though that if the patient is on other hypoglycemic medicines those would kick in and help and perhaps the MD doesn't want overkill, or they are brittle.

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Specializes in icu, er, transplant, case management, ps.

The coverage of Type 2 diabetics, while in the hospital, has changed in the past several years. Anyone entering for management of a disease that requires steroids, either IV or P.O., are generally put on a slding scale. Anyone entering for a surgical procedure, is instructed not to take their diabetes medication prior to their admission. A fasting blood sugar is generally drawn and if not, a finger stick is done. Based on that and on the type of IV the patient will receive, during surgery, results in a patient being given coverage with a short acting insulin. After surgery, if they remain in the hospital and on IV's, they may be put on an additional IV containing regular insulin. If they are not, they are generally put on a sliding scale. Sliding scale rates, as to when to cover, have dropped over the past several years. It is not held, by many physicians, that the closure to normal a diabetic's blood sugar is, the less complications they will suffer and the more rapid they will heal.

I live in a county of approximately 150,000 year round residents, with three community hospitals. While it is left up to the treating physician's to order coverage for diabetic patients, nurses may ask for a sliding scale covergae. Most physicians automatically order coverage and have lowered the rate of their sliding scale. The fear that a patient may go hypoglycemic is a rather unfounded one, I believe. The stress we are under causes our blood sugars to go up, not down, despite regular insulin. Most of us know the signs and symptoms of hypoglycemia. Try not to worry, we will call you if we need something to raise our blood sugar.

Woody:balloons:

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Specializes in PACU.

Alot of our patients start their sliding scales at 200 -- sometimes 150

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I agree, that's a bit outdated. There was an old idea that as long as diabetics were less than 200 that was fine. Some of the latest research advocates for more tighter control, particularly for wound healing.

I also agree though that if the patient is on other hypoglycemic medicines those would kick in and help and perhaps the MD doesn't want overkill, or they are brittle.

Hi Tweety, the patient is not on oral medications and she wasn't at home. She was on Novolin at home.

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The coverage of Type 2 diabetics, while in the hospital, has changed in the past several years. Anyone entering for management of a disease that requires steroids, either IV or P.O., are generally put on a slding scale. Anyone entering for a surgical procedure, is instructed not to take their diabetes medication prior to their admission. A fasting blood sugar is generally drawn and if not, a finger stick is done. Based on that and on the type of IV the patient will receive, during surgery, results in a patient being given coverage with a short acting insulin. After surgery, if they remain in the hospital and on IV's, they may be put on an additional IV containing regular insulin. If they are not, they are generally put on a sliding scale. Sliding scale rates, as to when to cover, have dropped over the past several years. It is not held, by many physicians, that the closure to normal a diabetic's blood sugar is, the less complications they will suffer and the more rapid they will heal.

I live in a county of approximately 150,000 year round residents, with three community hospitals. While it is left up to the treating physician's to order coverage for diabetic patients, nurses may ask for a sliding scale covergae. Most physicians automatically order coverage and have lowered the rate of their sliding scale. The fear that a patient may go hypoglycemic is a rather unfounded one, I believe. The stress we are under causes our blood sugars to go up, not down, despite regular insulin. Most of us know the signs and symptoms of hypoglycemia. Try not to worry, we will call you if we need something to raise our blood sugar.

Woody:balloons:

That's exactly what I was thinking! Patient acting strange? do a chemstick and check the blood sugar and then decide if it is too low/too high. You don't need a prescription for grape juice :lol2::lol2:

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I am on NPH and metformin, twice a day. When I am in the hospital, I am on a sliding scale of regular insulin. My sliding scale begins at 182 with one unit of regular insulin to be given. My sliding scale goes up as my blood sugar rises. When I first started on a sliding scale, in 2000, it didn't start until my blood sugar is 200 plus, then I received two units of regular insulin. The sliding scale is left to the individual physician. It has been established that diabetic patients heal faster and better when their blood sugar is kept as close to normal as possible.

Woody:balloons:

Hey Woody--so, they don't keep you going on NPH in the hospital? I have been reading articles lately saying that current best practice is to keep T1 folks on Glargine for basal and a lispro for sliding scale, relative to meal times. For T2, an NPH for basal and regular sliding scale q4-6 hours. Generally, I think the goal is to keep postprandial glucose

I always see pts--usually T2--who are only prescribed sliding scale regular with no basal insulin. It's frustrating--when their BS is >200 each time you check them, even though you're "covering" them--their glucose is obviously not being controlled.

-Kan

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Specializes in icu, er, transplant, case management, ps.
Hey Woody--so, they don't keep you going on NPH in the hospital? I have been reading articles lately saying that current best practice is to keep T1 folks on Glargine for basal and a lispro for sliding scale, relative to meal times. For T2, an NPH for basal and regular sliding scale q4-6 hours. Generally, I think the goal is to keep postprandial glucose

I always see pts--usually T2--who are only prescribed sliding scale regular with no basal insulin. It's frustrating--when their BS is >200 each time you check them, even though you're "covering" them--their glucose is obviously not being controlled.

-Kan

Yes I am kept on NPH, it is what works for me. My sliding scale coverage starts at 160, now and I get two units instead of one, especially when I am on solu medrol IV. That combined with my own reduction in my daily carbohydrate intake, plus making sure my IVs contain no glucose, generally helps to keep my blood sugar under 120 except after I've received the solu medrol. Then I get the coverage. And we had decided to attempt to increase my NPH a little, timing my solu medrol dose when it hits peak, to see if it helps.

Woody:balloons:

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to all you nurses out there, it is quite evident that you have limited knowledge about why and when sliding scale insurlin should be ordered. Please educate yourselves before giving education to student nurses and especially before taking care of a diabetic patient. Ask an Endo or a Certified Diabetes Educator. They will give you the correct information not misinformation.

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Specializes in Assisted Living, Med-Surg/CVA specialty.
to all you nurses out there, it is quite evident that you have limited knowledge about why and when sliding scale insurlin should be ordered. Please educate yourselves before giving education to student nurses and especially before taking care of a diabetic patient. Ask an Endo or a Certified Diabetes Educator. They will give you the correct information not misinformation.
Wow, I dunno this struck me as a bit rude.

It might help you to tell people what they said was wrong or "misinformation" rather than just saying "You said something wrong, go educate yourselves". I think constructive criticism should direct people in the right direction.

Plus, this thread is almost a year old. :uhoh3:

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Specializes in ortho/neuro/general surgery.
to all you nurses out there, it is quite evident that you have limited knowledge about why and when sliding scale insurlin should be ordered. Please educate yourselves before giving education to student nurses and especially before taking care of a diabetic patient. Ask an Endo or a Certified Diabetes Educator. They will give you the correct information not misinformation.

perhaps, since you're the expert, you could throw out a few bits about what we're doing wrong

i personally work nites and have been dealing with the questions of when to give coverage insulin for breakfast for 4 yrs and gotten very few, if any, straight answers

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to all you nurses out there, it is quite evident that you have limited knowledge about why and when sliding scale insurlin should be ordered. Please educate yourselves before giving education to student nurses and especially before taking care of a diabetic patient. Ask an Endo or a Certified Diabetes Educator. They will give you the correct information not misinformation.

Why don't you point us in the right direction so that we can educate ourselves? So, was EVERYTHING discussed on this thread incorrect? Or only parts of it? And what sort of reference could you point us to? It's hardly helpful to say "You don't know what you are talking about," but leave it at that. If you were honestly interested in correcting our misconceptions about sliding scale insulin, I would think you would give us a little more information. Or maybe you are just trying to put people down, make yourself feel better, stir the pot a bit? I wonder if you are even a diabetic specialist...

So, which is it: troll or diabetes specialist? Prove it.

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Specializes in icu, er, transplant, case management, ps.
Why don't you point us in the right direction so that we can educate ourselves? So, was EVERYTHING discussed on this thread incorrect? Or only parts of it? And what sort of reference could you point us to? It's hardly helpful to say "You don't know what you are talking about," but leave it at that. If you were honestly interested in correcting our misconceptions about sliding scale insulin, I would think you would give us a little more information. Or maybe you are just trying to put people down, make yourself feel better, stir the pot a bit? I wonder if you are even a diabetic specialist...

So, which is it: troll or diabetes specialist? Prove it.

I do not know the educational background of the original poster, you are referring to. But thinking on diabetes and coverage has changed, even in the past few years. There is now a group that believes that any diabetic, admitted to a facility, should be put on a IV drip of regular insulin. And they do not recommend using the sliding scale. I have been hospitalized under both. The IV drip worked just fine because I was in ICU and on high concentrated glucose IV. My nurses were able to keep my blood sugars under 130 which was fine with me. Most but not all diabetics can tell you about their sliding scale, if they are on one but you shouldn't depend on them. Any patient who is on insulin needs to be on a sliding scale or an IV drip of regular insulin. Anyone receiving any medications that cause a rise in blood glucose should be covered. If the physician is not familiar with this suggest an endocrinologist consult for coverage.

Woody:twocents:

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