What is the insulin sliding scale for a patient weighing 70 kilograms?

From the Guidelines

For a 70 kg adult, a simplified insulin sliding scale may be used, where for premeal glucose >250 mg/dL, give 2 units of short- or rapid-acting insulin, and for premeal glucose >350 mg/dL, give 4 units of short- or rapid-acting insulin, as recommended by the 2024 standards of care in diabetes 1. When implementing this sliding scale, it's essential to consider individual patient characteristics and adjust the insulin dose accordingly. The goal is to maintain premeal glucose levels between 90-150 mg/dL, and adjustments should be made every 2 weeks based on finger-stick glucose testing performed before lunch and before dinner 1. Some key points to consider when using the sliding scale include:

• Do not use rapid- and short-acting insulin at bedtime, as recommended by the 2024 standards of care in diabetes 1
• Stop the sliding scale when it is no longer needed daily
• Adjust the insulin dose and/or add glucose-lowering agents based on finger-stick glucose testing results
• If 50% of premeal finger-stick values over 2 weeks are above goal, increase the dose or add another agent
• If more than 2 premeal finger-stick values per week are below 90 mg/dL, decrease the dose of medication 1. It's crucial to monitor blood glucose levels closely and adjust the sliding scale as needed to prevent hyperglycemia and hypoglycemia, and to achieve the best possible outcomes in terms of morbidity, mortality, and quality of life.

From the Research

Insulin Sliding Scale for 70 kg

• The provided studies do not directly address the insulin sliding scale for a 70 kg individual. However, they discuss the effectiveness of sliding scale insulin in various contexts.
• A study from 2005 2 compared the efficacy of an algorithm using 70/30 insulin with traditional sliding scale insulin dosing for glycemic control in hospitalized patients with type 2 diabetes.
• The study found that patients treated with the 70/30 insulin algorithm achieved better glycemic control than those receiving traditional sliding scale insulin dosing.
• Another study from 2010 3 suggested that adopting a proactive approach to managing diabetes, such as using supplemental insulin or basal insulin, is more effective and safer than sliding scale insulin.
• A meta-analysis from 2015 4 found that sliding-scale insulin did not provide any benefits in blood glucose control and was accompanied by an increased incidence of hyperglycemic events.
• A Cochrane review from 2018 5 compared sliding scale insulin with other strategies for glycemic control in non-critically ill hospitalized adults with diabetes mellitus and found that the certainty of the evidence was low to very low, making it uncertain which insulin strategy is best.

Key Findings

• Sliding scale insulin may not be the most effective approach for glycemic control in hospitalized patients.
• Alternative strategies, such as basal-bolus insulin or supplemental insulin, may be more effective and safer.
• The evidence for sliding scale insulin is limited, and more research is needed to determine its effectiveness.

Studies

• 6: Compared once-daily glargine insulin with twice-daily NPH/regular insulin for control of hyperglycemia in inpatients after cardiovascular surgery.
• 3: Discussed the limitations of sliding scale insulin and suggested alternative approaches to managing diabetes in hospitals.
• 5: Compared sliding scale insulin with other strategies for glycemic control in non-critically ill hospitalized adults with diabetes mellitus.
• 2: Compared the efficacy of an algorithm using 70/30 insulin with traditional sliding scale insulin dosing for glycemic control in hospitalized patients with type 2 diabetes.
• 4: Conducted a meta-analysis of randomized controlled trials to evaluate the efficacy and possible adverse effects of sliding-scale insulin in hospitalized patients.