Sliding Scale Protocol for NovoRapid (Insulin Aspart) Based on Blood Glucose in mmol/L
For patients requiring short-term insulin coverage, a simplified sliding scale for NovoRapid (insulin aspart) should use the following dosing guidelines: 2 units for blood glucose >13.9 mmol/L and 4 units for blood glucose >19.4 mmol/L. 1
Standard Sliding Scale Protocol for NovoRapid
| Blood Glucose (mmol/L) | NovoRapid (Insulin Aspart) Dose |
|---|---|
| <5.0 | No insulin, consider reducing basal insulin |
| 5.0-13.9 | No correction dose needed |
| >13.9 | 2 units |
| >19.4 | 4 units |
Implementation Guidelines
When to Use Sliding Scale
- Use as a temporary measure while adjusting prandial insulin doses
- Appropriate for short-term management (<24 hours) in patients not previously treated with insulin
- Should not be used as the sole method of glucose control for extended periods 2, 3
- Stop sliding scale when no longer needed daily 1
Administration Timing
- Administer before meals (pre-prandial)
- Do not use rapid-acting insulin like NovoRapid at bedtime to avoid nocturnal hypoglycemia 4
- Check blood glucose before each meal and at bedtime
Monitoring and Adjustment
- Monitor blood glucose every 4-6 hours for patients who are not eating
- For patients on regular meals, check before meals and at bedtime
- If 50% of pre-meal glucose values over 2 weeks are above target (5.0-8.3 mmol/L), increase the basal insulin dose by 2 units or add another agent 1
- If >2 pre-meal glucose values/week are <5.0 mmol/L, decrease the dose of medication 1
Special Considerations
Elderly Patients
- Target blood glucose range: 5.0-8.3 mmol/L (90-150 mg/dL) 4
- Use simplified sliding scale as outlined above
- Consider reducing doses for frail elderly patients or those with renal/hepatic impairment
Hospitalized Patients
- For hospitalized patients requiring more intensive management, consider a more detailed scale:
| Blood Glucose (mmol/L) | Low-Dose Scale | Moderate-Dose Scale | High-Dose Scale |
|---|---|---|---|
| 7.8-10.0 | 1 unit | 2 units | 3 units |
| 10.1-12.2 | 2 units | 4 units | 6 units |
| 12.3-14.4 | 3 units | 6 units | 9 units |
| 14.5-16.7 | 4 units | 8 units | 12 units |
| >16.7 | 5 units | 10 units | 15 units |
- Select appropriate scale based on insulin sensitivity:
- Low-dose: Insulin sensitive, elderly, renal/hepatic impairment
- Moderate-dose: Average patient
- High-dose: Insulin resistant, obese, on steroids
Hypoglycemia Management Protocol
- Define hypoglycemia as blood glucose <3.9 mmol/L
- For mild-moderate hypoglycemia (3.0-3.9 mmol/L) in conscious patients:
- Administer 15-20g oral carbohydrate (e.g., 3-4 glucose tablets, 150-200 mL juice)
- Recheck blood glucose after 15 minutes
- Repeat treatment if blood glucose remains <3.9 mmol/L
- For severe hypoglycemia (<3.0 mmol/L) or unconscious patients:
- Administer IV dextrose 25g (50 mL of 50% solution) or
- Glucagon 1mg IM/SC if IV access not available 4
Limitations and Pitfalls
- Sliding scale insulin alone is often ineffective for sustained glucose control 3, 5
- Can lead to wide glucose fluctuations and increased risk of hyperglycemic events 3
- Should be used as a supplement to basal insulin, not as the sole insulin regimen
- Requires consistent monitoring and documentation to be effective 5
By following this protocol, you can implement a standardized approach to short-term glucose management using NovoRapid insulin while minimizing the risks of hypo- and hyperglycemia.