Sliding Scale Insulin

[RN BSN 2009]

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

[traumaRUs, MSN, APRN]

Let's debate the topic, not the poster. However, if someone purpoorts to be an expert then it would be very helpful to the rest of us if you could address the question. Thanks.

[kimcake]

The reason that has been explained to me while working on the floors is some diabetics are more sensitive to insulin then others. This person maybe more sensitive; which means that their own insulin production should bring them back down to normal range and with the added insulin injection from the sliding scale would cause the patient to go into a hypoglycemic state.

A select few physician's are starting to steer away from the sliding scale and base their insulin more on prandial, basal, and coverage based on carbohydrate counting.

[Trubie, LPN]

I work in LTC, and have 2 doctors. One doc starts his s/s at 150, the other at 180. It is not based on patient history.

[DMspecialist]

I referred you all to an endocrinologist or Certified diabetes Educator because they are the people who would be most likely to answer your questions correctly. All Type 1 diabetics should be on basal/bolus insulin in the hospital or at home. Basal should be continued when they are NPO...remember their pancrease does not produce any insulin and our bodies must have insulin. Without basal insulin they will become hyperglycemic and can easily go into DKA. When eating they should be on insulin to CHO ratio for meal coverage and correction coverage. Some On Med/Surg Type 2 diabetics and patients on steriods, TPN, GTubes may benefit from sliding scale but if frequent correction boluses are required or BG continue > 180 basal should be initiated. Always look at what home meds are to see what their requirements have been. If they are on insulin at home they should be on basal insulin inpatient. Sliding scale is just chasing high blood sugar not preventing them. Also it is useful to have A1c results available. Oral medications are usually not effective in hospitalized patients because of NPO and poor oral intake. Remember sulfonylureas continue to increase production of insulin even when patient is not eating and are especially dangerous in patients with renal insufficiency and the elderly. Many patients in any critical care units will benefit from an insulin drip if their BG is over 150. We put all our open heart patients on insulin drip if their BG is 120 or above whether Diabetic or not for 72 hours. Many severe trauma and stroke patients also benefit from the drip. We use glucostabilizer which is computerized software program used to calculate insulin infusion rate to maintain BG levels with hospital determined target. BG is checked hourly and drip rate is calculated accordingly. We have different parameters depending on the unit. We also use the glucostabilizer for DKA, HHS and other uncontrolled diabetic patients.

Diabetes blood glucose control is complicated and should be followed and regulated on a daily basis based on BG results.

I may have seemed "rude" but this is nursing 101 and any nurse working in a hospital should be knowledgable It is a matter of life and death for your patient It IS serious for them. Poor BG control leads to poor outcomes.

[blondy2061h, MSN, RN]

Nevermind