From the Guidelines
Regular human insulin (Humulin R or Novolin R) is generally considered the safest insulin for sliding scale regimens due to its predictable onset and duration of action. For sliding scale insulin therapy, short-acting insulin is typically administered before meals and at bedtime based on blood glucose readings. A common starting regimen might be: 0 units for blood glucose <150 mg/dL, 2 units for 150-200 mg/dL, 4 units for 201-250 mg/dL, 6 units for 251-300 mg/dL, and 8 units for >300 mg/dL, though this should be individualized 1. Regular insulin begins working in 30 minutes, peaks in 2-3 hours, and lasts 5-8 hours, making it appropriate for managing post-meal glucose excursions.
While rapid-acting analogs like lispro, aspart, or glulisine can also be used, they have a quicker onset and shorter duration, potentially increasing hypoglycemia risk if not carefully monitored 1. Sliding scale insulin is most effective when combined with basal insulin rather than used alone, as monotherapy can lead to wide glucose fluctuations. Regular monitoring of blood glucose is essential when using any sliding scale regimen to prevent hypoglycemia and adjust dosing as needed.
Some key points to consider when using sliding scale insulin regimens include:
- Starting with a low dose and titrating up as needed to minimize hypoglycemia risk
- Using a consistent regimen to simplify dosing and reduce errors
- Monitoring blood glucose regularly to adjust dosing and prevent hypoglycemia
- Considering the use of basal insulin in combination with sliding scale insulin to improve glucose control 1.
Overall, the choice of insulin for sliding scale regimens should be individualized based on patient factors, such as glucose control goals, lifestyle, and medication adherence. Regular human insulin is a safe and effective option for sliding scale regimens, but other insulins may be suitable depending on the specific patient needs.
From the FDA Drug Label
However, the sensitivity of the patients to insulin did change, with an increased response to insulin as the renal function declined. Careful glucose monitoring and dose adjustments of insulin, including HUMALOG, may be necessary in patients with renal dysfunction [see Warnings and Precautions (5. 5)]. Careful glucose monitoring and dose adjustments of insulin, including HUMALOG, may be necessary in patients with hepatic dysfunction.
The safest insulin for sliding scale cannot be determined from the provided information. Lispro (HUMALOG) is a type of insulin that requires careful glucose monitoring and dose adjustments, especially in patients with renal dysfunction or hepatic dysfunction. However, the FDA drug label does not provide a direct comparison of the safety of different insulins for sliding scale use.
- Key considerations for sliding scale insulin use include:
- Renal function: Patients with renal impairment may require dose adjustments.
- Hepatic function: Patients with liver failure may require dose adjustments.
- Glucose monitoring: Careful monitoring is necessary to adjust insulin doses. 2
From the Research
Safest Insulin for Sliding Scale
- The safest insulin for sliding scale is not explicitly stated in the provided studies, but some insights can be gained from the comparisons of different insulin types.
- A study from 2015 3 suggests that sliding-scale insulin may not be the most effective approach for blood glucose control, as it was associated with an increased incidence of hyperglycemic events.
- Comparisons of rapid-acting insulin analogs, such as insulin aspart and lispro, have shown that they have similar efficacy and safety profiles in patients with type 1 and type 2 diabetes 4, 5, 6, 7.
- Insulin aspart and lispro have been shown to be equally effective in controlling postprandial blood glucose excursions 5, 6, 7.
- A study from 2003 7 found that insulin aspart and lispro had similar effects on glucose and fat metabolism in patients with type 1 diabetes.
- Another study from 2013 4 found that insulin aspart was more effective than insulin glulisine in controlling 2- and 4-hour postprandial blood glucose excursions in prepubertal children with type 1 diabetes.
Key Findings
- Sliding-scale insulin may not be the most effective approach for blood glucose control 3.
- Insulin aspart and lispro have similar efficacy and safety profiles 4, 5, 6, 7.
- Insulin aspart and lispro are equally effective in controlling postprandial blood glucose excursions 5, 6, 7.