What is the protocol for a Novolog (insulin aspart) sliding scale?

Novolog (Insulin Aspart) Sliding Scale Protocol

A simplified sliding scale protocol for Novolog (insulin aspart) should use premeal blood glucose measurements with standardized insulin doses, rather than relying solely on sliding scale insulin which is strongly discouraged as a standalone treatment strategy. 1

Standard Novolog Sliding Scale Protocol

Premeal Blood Glucose Monitoring

• Check blood glucose before each meal and at bedtime
• For patients with poor oral intake, check every 4-6 hours

Recommended Sliding Scale Framework

• Blood glucose <150 mg/dL: No correction dose
• Blood glucose 150-200 mg/dL: 2 units Novolog
• Blood glucose 201-250 mg/dL: 4 units Novolog
• Blood glucose 251-300 mg/dL: 6 units Novolog
• Blood glucose 301-350 mg/dL: 8 units Novolog
• Blood glucose >350 mg/dL: 10 units Novolog and notify provider

Important Considerations

1. Avoid using sliding scale as sole therapy

   • Sliding scale insulin alone is strongly discouraged and associated with poor glycemic control 1
   • Should be used as a supplement to basal insulin or as a temporary measure

2. Combine with basal insulin

   • Basal-bolus approach is more effective than sliding scale alone 1
   • For insulin-naive patients, start with total daily insulin dose of 0.3-0.5 units/kg
   • Divide as 50% basal insulin and 50% rapid-acting insulin before meals

3. Timing of administration

   • Administer Novolog immediately before meals
   • If oral intake is poor or unpredictable, administer immediately after meals based on actual carbohydrate consumption 1
   • Do not use rapid-acting insulin at bedtime 1

4. Adjustments for special populations

   • For older adults (>65 years), renal impairment, or poor oral intake: Use lower doses
   • Start with 0.1-0.25 units/kg for patients at high risk of hypoglycemia 1

Simplified Protocol for Older Adults

For older adults, the American Diabetes Association recommends a simplified sliding scale 1:

• Premeal glucose >250 mg/dL: Give 2 units of Novolog
• Premeal glucose >350 mg/dL: Give 4 units of Novolog

Monitoring and Adjustment

• Review blood glucose patterns every 24-48 hours
• If >50% of readings are above target: Increase correction doses by 1-2 units
• If any blood glucose <70 mg/dL: Decrease correction doses by 1-2 units
• Target blood glucose range: 90-150 mg/dL before meals (may be adjusted based on individual health status) 1

Common Pitfalls to Avoid

1. Relying solely on sliding scale insulin

   • This reactive approach leads to poor glycemic control and increased hyperglycemia 1
   • Always combine with scheduled basal insulin when possible

2. Inappropriate timing of insulin administration

   • Administering Novolog too early before meals can cause hypoglycemia
   • Administering too late after meals can lead to postprandial hyperglycemia

3. Failure to adjust for changing clinical conditions

   • Adjust doses for changes in nutritional status, steroid use, or acute illness
   • Temporarily discontinue or reduce doses during NPO status

4. Overtreatment in vulnerable populations

   • Use more conservative scales in elderly, renally impaired, or malnourished patients
   • Consider higher glucose targets (140-180 mg/dL) in hospitalized patients 1

By following this protocol and avoiding the common pitfalls, Novolog sliding scale can be used effectively as part of a comprehensive insulin regimen to manage blood glucose levels and reduce the risk of complications associated with poor glycemic control.