From the Research
Moderate sliding scale mealtime insulin (Regular Insulin) should be administered 30 minutes before meals based on pre-meal blood glucose readings, with dosing as follows: for blood glucose levels 70-150 mg/dL, give 0 units; 151-200 mg/dL, give 2 units; 201-250 mg/dL, give 4 units; 251-300 mg/dL, give 6 units; 301-350 mg/dL, give 8 units; and for levels above 350 mg/dL, give 10 units and notify the healthcare provider. Always check blood glucose before administering insulin, and use a proper insulin syringe or pen to inject subcutaneously into rotating sites such as the abdomen, thighs, or upper arms. Regular insulin has an onset of action in 30-60 minutes, peaks in 2-3 hours, and lasts 5-8 hours, making the timing before meals important for optimal glucose control, as noted in various studies 1, 2, 3, 4, 5. If blood glucose falls below 70 mg/dL, treat the hypoglycemia immediately with 15 grams of fast-acting carbohydrates and recheck levels after 15 minutes. Document all insulin doses given and the corresponding blood glucose readings. This sliding scale approach allows for personalized insulin dosing based on actual glucose levels, helping to prevent both hyperglycemia and hypoglycemia. Key considerations include the pharmacokinetic profiles of different insulin analogs, such as insulin aspart and lispro, which have been compared in several studies 3, 4, 5, but the most recent and highest quality study 5 suggests that glulisine has comparable glucose control to lispro/aspart. However, the specific instructions for moderate sliding scale mealtime insulin provided here prioritize the management of blood glucose levels in relation to meal times, emphasizing the importance of pre-meal blood glucose monitoring and tailored insulin dosing.