What is the protocol for a sliding scale of regular insulin (Novolin R)?

From the Guidelines

The use of a sliding scale of regular insulin should be discouraged in favor of a basal-bolus insulin regimen, which has been shown to provide better glycemic control and reduce the risk of complications in hospitalized patients with type 2 diabetes 1.

Protocol for Sliding Scale of Regular Insulin

Although not recommended, if a sliding scale of regular insulin is to be used, it should be personalized by a healthcare provider based on the patient's insulin sensitivity, weight, and overall diabetes management goals.

• The patient's blood glucose level should be checked before meals and at bedtime, and a specific dose of regular insulin (Novolin R) should be administered based on predetermined ranges.
• For example, if the blood glucose is 150-200 mg/dL, 2 units of insulin might be injected; if 201-250 mg/dL, 4 units; if 251-300 mg/dL, 6 units; and so on.
• Regular insulin begins working within 30 minutes, peaks in 2-3 hours, and lasts 3-6 hours, making it appropriate for mealtime coverage.

Important Considerations

• When implementing a sliding scale, glucose monitoring supplies and fast-acting carbohydrates should be kept nearby to treat potential hypoglycemia.
• The sliding scale approach is generally considered reactive rather than preventative and is often used in hospital settings or as a supplement to a basal-bolus insulin regimen rather than as a standalone treatment for diabetes.
• A basal-bolus insulin regimen, which includes the administration of basal insulin and rapid-acting insulin before meals, plus corrective doses of rapid-acting insulin, is a more effective and recommended approach for managing diabetes in hospitalized patients 1.
• The American Diabetes Association recommends a goal of 90-150 mg/dL before meals, and the dose of insulin should be adjusted every 2 weeks based on fingerstick glucose testing performed before lunch and before dinner 1.

From the Research

Protocol for Sliding Scale of Regular Insulin (Novolin R)

• The protocol for a sliding scale of regular insulin (Novolin R) is typically based on the patient's blood glucose level, with the goal of maintaining a target blood glucose range 2, 3, 4, 5, 6.
• However, the use of sliding-scale insulin regimens has been questioned due to their potential ineffectiveness in preventing hyperglycemia and their association with an increased incidence of hyperglycemic events 3, 4.
• Studies have shown that basal-bolus insulin regimens are more effective in achieving glycemic control than sliding-scale insulin regimens 5, 6.
• The American Diabetes Association recommends the use of basal-bolus insulin regimens for the management of hyperglycemia in hospitalized patients, rather than sliding-scale insulin regimens 5.

Key Considerations

• Blood glucose targets should be individualized based on the patient's condition and medical history 5.
• Frequent blood glucose monitoring is critical for adjusting insulin doses and preventing hypoglycemia 5.
• The use of modern insulin analogs, such as long-acting basal insulin analogs and rapid-acting insulin analogs, may offer advantages over traditional human insulins 5.

Alternative Approaches

• Basal-bolus insulin regimens, which include a combination of long-acting basal insulin and rapid-acting bolus insulin, may be a more effective approach for managing hyperglycemia in hospitalized patients 5, 6.
• Continuous intravenous insulin infusion may be preferred for critically ill patients or those with severe hyperglycemia 5.