From the Guidelines
For managing blood glucose levels using a low-dose insulin sliding scale, administer 2 units of short- or rapid-acting insulin for premeal glucose levels >250 mg/dL and 4 units for levels >350 mg/dL, as recommended by the most recent guidelines 1.
Key Considerations
- The goal is to maintain blood glucose levels between 90-150 mg/dL before meals, with adjustments based on overall health and goals of care 1.
- It is essential to monitor for signs of low blood sugar and keep fast-acting glucose available to treat hypoglycemia if it occurs.
- The sliding scale approach should be used in conjunction with patient and drug characteristics to guide decision-making, as depicted in relevant figures and tables 1.
Administration Guidelines
- Administer subcutaneous insulin based on pre-meal blood glucose readings, using a simplified sliding scale as needed.
- Stop the sliding scale when not needed daily, and adjust insulin doses and/or add glucose-lowering agents every 2 weeks based on fingerstick glucose testing performed before lunch and before dinner.
- If 50% of premeal fingerstick values over 2 weeks are above goal, increase the dose or add another agent; if more than 2 premeal fingerstick values per week are below 90 mg/dL, decrease the dose of medication 1.
Important Reminders
- Regular Insulin has an onset of action in 30-60 minutes, peaks in 2-3 hours, and lasts 5-8 hours, so timing administration 30 minutes before meals is crucial.
- Always document blood glucose readings and insulin doses administered to ensure effective management and minimize the risk of hypoglycemia.
- The low-dose scale is particularly suitable for insulin-sensitive patients, elderly individuals, or those with renal impairment who may be at higher risk for hypoglycemia 1.
From the Research
Low-Dose Insulin Sliding Scale Instructions
The management of blood glucose levels using a low-dose insulin sliding scale involves adjusting the dose of insulin based on the patient's blood glucose levels. Here are the key points to consider:
- The traditional sliding scale insulin (SSI) method may not be effective in improving target glucose values among adult medical inpatients 2.
- The timing of blood glucose measurement can affect the required SSI dose, and it is recommended to measure blood glucose and administer insulin immediately prior to mealtime 2.
- The use of a basal plus regimen with glargine once daily plus corrective doses with glulisine insulin before meals can result in glycemic control similar to a standard basal-bolus regimen 3.
- Sliding scale insulin regimens are often not adjusted, and despite blood glucose levels remaining persistently elevated, corresponding adjustments in either the timing or the dose of insulin are made infrequently 4.
Key Considerations
- The risk of hypoglycemia is a concern when using sliding scale insulin, and severe hypoglycemic episodes can occur 5.
- The mean blood glucose levels can be higher in patients using sliding scale insulin compared to those using a basal-bolus insulin strategy 5.
- The certainty of the evidence comparing sliding scale insulin with basal-bolus insulin is low to very low, and more research is needed to determine the best insulin strategy for non-critically hospitalized adults with diabetes mellitus 5.
Administration Guidelines
- Blood glucose levels should be measured immediately prior to mealtime 2.
- Insulin doses should be adjusted based on the patient's blood glucose levels, with higher doses given for higher blood glucose levels 3, 4.
- The use of a basal plus regimen with glargine once daily plus corrective doses with glulisine insulin before meals can be an effective alternative to the use of a basal-bolus regimen 3.