How often should finger sticks be performed for an admitted patient on sliding scale insulin?

Finger Stick Frequency for Hospitalized Patients on Sliding Scale Insulin

For hospitalized patients on sliding scale insulin, finger stick blood glucose monitoring should be performed before meals and at bedtime for patients who are eating, or every 4-6 hours for patients who are not eating. 1

Monitoring Schedule Based on Patient's Nutritional Status

For Patients Who Are Eating:

• Perform finger stick glucose testing immediately before meals
• Perform additional testing at bedtime
• Align insulin injections with meals
• For patients with poor oral intake, administer prandial insulin immediately after the patient eats, with the dose adjusted for the amount consumed

For Patients Who Are Not Eating:

• Perform finger stick glucose testing every 4-6 hours
• For patients on continuous enteral/parenteral nutrition, maintain the regular testing schedule

Rationale for Timing of Glucose Monitoring

The timing of blood glucose measurement significantly affects the required sliding scale insulin dose 2. Blood glucose measurement and insulin administration should be accomplished immediately prior to mealtime for optimal effectiveness. This approach ensures:

1. Accurate assessment of current glucose levels
2. Appropriate insulin dosing based on actual needs
3. Reduced risk of hypoglycemic events
4. Better alignment between insulin action and food intake

Important Considerations for Sliding Scale Insulin Use

Limitations of Sliding Scale Insulin

• Traditional sliding scale insulin (SSI) alone has not been shown to improve target glucose values among adult inpatients 2
• Use of only sliding scale insulin regimen in the inpatient setting is strongly discouraged 1
• SSI has been on the Beers Criteria of Potentially Inappropriate Medications since 2012 3

Preferred Insulin Regimens for Hospitalized Patients

• For patients with poor oral intake or NPO status: Basal insulin or basal plus correction insulin regimen is preferred 1
• For patients with good nutritional intake: An insulin regimen with basal, prandial, and correction components is preferred 1

Monitoring Protocols for Specific Insulin Regimens

For Basal-Bolus Insulin Regimens:

• Pre-meal finger sticks (3 times daily)
• Bedtime finger stick (1 time daily)
• Additional testing if symptoms of hypoglycemia occur

For Continuous Intravenous Insulin (Critical Care):

• More frequent bedside blood glucose testing ranging from every 30 minutes to every 2 hours 1

Safety Considerations

• Mandatory safety standards prohibit sharing of lancets, testing materials, and needles 1
• Be aware that capillary blood glucose readings can be affected by:
  • Perfusion issues
  • Edema
  • Anemia/erythrocytosis
  • Several medications commonly used in hospitals 1

Pitfalls to Avoid

1. Relying solely on sliding scale insulin: Studies show this approach is often ineffectual and prone to deficiencies in monitoring, documentation, and prescribing soundness 4

2. Poor timing of glucose measurements: Misalignment between glucose testing, insulin administration, and meals can lead to suboptimal glycemic control 2

3. Failure to adjust insulin regimens: Despite persistently elevated glucose levels, adjustments to insulin timing or dosing are often not made, with one study showing 81% of sliding scale regimens were never adjusted 4

4. Inadequate documentation: Uncertainties or missing information related to execution, timing, blood glucose levels, or insulin dose can occur in approximately 30% of insulin-related care points 4

Following these evidence-based monitoring protocols will help optimize glycemic control and reduce the risk of both hyper- and hypoglycemic events in hospitalized patients on sliding scale insulin.