sliding scale insulin does it work in intensive care?

nurseyperson · May 6, 2000

In our ICU we don't have standing orders for sliding scale, but most doctors order about eh same...which is....1 unit of regular insulin for each 10 (dl?) over either 180 or 200. So if the order is for over 180, if your blood sugar is 290, you give 11units.

generally up to a max of 400, then call the doctor, or if continues to run high most of the time. It generally works well, but lower blood sugars would be nice. There are numerous studies out there that show high blood sugars deter healing...contributing to infection, poor wound healing, and of course everything that a high blood sugar does to the body in general, in good health or bad, which of course would increase the time the patients spend in ICU. Don't have any specific studies for you.

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nurseyperson

SusieNurse · May 22, 2000

We have a city-wide sliding scale and I think is lends itself to better control in the unit. We use it to maintain BG levels under 150. When we have out of control sugars, a call to the Doc can usually bag us a drip when we want one. The doctors do not have to write out sliding scales, we can be on top of it, check as often as needed. I feel we augment healing by controling sugars and the city-wide scale is a quick and easy-to-use tool to accomplish this. Their routine at home rarely works well when they are sick and stressed. This really gets them over the rough spots.

Originally posted by hilary:
Please can anyone help me? I am currently auditing our protocol on blood glucose monitoring and guidelines for the administration of insulin and I'm wondering if a sliding scale might be better than our current guidelines!
Also I'm looking for info on whether or not control of blood glucose affects outcome in the intensive care patient.
PLEASE PLEASE HELP IF YOU CAN !!!!!
Thanks, Hilary.

BritRN · Oct 6, 2000

we have a insulin protocol devised by our Pharmacist which works really well and keeps blood sugar levels between the safe zone of 7-11 mmols. if interested in viewing it email me and i will email you a copy for you to see and possibly trial.

Good Luck!

Doc · Feb 2, 2001

Our ICU doctors generally prescribe a fixed dose of insulin, based on a collection blood specimen (not a glucometer BSL reading). When levels stay above 11.0 mmol/L, we increase the insulin infusion. The rate to increase it depends on the patient, but I would say 1ml/hr per mmol over 10 mmol is a good starting point. Take another BSL after 1/2 hr and finetune it. Document this in the flowchart and pt notes. Sorry I don't have any references but it makes sense for the rate to be individualised to the pt and based on his/her BSL rather than on a gung-ho sliding scale.