Insulin regimens for type 2 diabetes using one daily injection of insulin. Canadian agency for drugs and technologies in health 600865 carling avenue, ottawa, ontario, 1s 5s8. Read this booklet and the insulin passport alongside all the other information about. National subcutaneous insulin chart for acute hospitals pdf 208kb. Insulin dosing worksheet sliding scale insulin to carbohydrate ratio 1 unit. Adult sliding scale for insulin aspart novolog umc health system. There are different types of insulin depending on how quickly they work, when they peak, and how long they last. Correction insulin sliding scale, supplemental, bolus. Optimizing glucose management in hospitalized patients. Insulin injection resources american association of. In this therapy model, blood sugar is taken about four times.
Stepwise dosing and titration of insulin for type 2 diabetes. This sliding scale assumes that 1 unit of regular will. For information about the sort evidence rating system, go to orgafpsort. Getting glucose to goal in the hospital frontline nursing. Controlling blood glucose levels in hospital patients. Sliding scale and basalbolus insulin regimens are two options available for the treatment of severe or acute hyperglycemia in type 2 diabetes mellitus patients. Unless used for occasional coverage for short periods of time, do not leave patients on regular insulin sliding scale riss as only form of treatment. Sliding scale insulin ssi, a treatment regimen that has been around. Samplea patient information booklet for adults who have diabetes. Sliding scale regular insulin ssi in the management of patients with diabetes was the standard practice as early as 1934 1 and was also used in the hyperglycemic emergency diabetic ketoacidosis 2. Another longheld tradition is use of the sliding scale for glycemic control in hospitalized patients, with insulin doses based on the patients blood glucose bg level. Historically, sliding scale regular insulin was the issue now rapid acting insulins are a concern.
Patients treated with slidingscale insulin alone had blood glucose levels. It is used to improve blood sugar control in patients with dmii. The sliding scale group was treated using ad hoc sliding scale. Some people on insulin use a sliding scale, while others have set doses each day.
Longacting insulin glarginedetemir or nph, once or. Each handout is written in easy to understand language with. Veterinary practice guidelines 2018 aaha diabetes management guidelines for dogs and cats ellen behrend, vmd, phd, dacvim, amy holford, vmd, dacvimy, patty lathan, vmd, dacvim, renee rucinsky, dvm, dabvpy, rhonda schulman, dvm, dacvim abstract diabetes mellitus dm is a common disease en countered in canine and feline medicine. Jan 01, 2018 type 2 diabetes mellitus is a chronic, progressive disease characterized by multiple defects in glucose metabolism, the core of which is insulin resistance in muscle, liver, and adipocytes and. Guide to starting and adjusting insulin for type 2. Continue to repeat 10 units subcut and poc blood sugar checks every 1 hour until blood glucose is less than 300 mgdl, then resume normal poc blood sugar check and insulin regular sliding scale. In those patients managed with insulin infusion, adjust hourly to achieve target.
Calculate insulin dose for food add up all the carbohydrates in your meal. Selfmonitoring of blood glucose should be individualized. The amount of carbohydrate to be eaten at each meal is preset. Correctional subcutaneous sliding scale insulin to be administered indicate frequency. Type 2 diabetes adult outpatient insulin guidelines if postmeal glucose levels 180. Dosage of human insulin, which is always expressed in usp units, must be based on results of blood and urine glucose tests and must be carefully individualized to optimal effect.
Veterinary practice guidelines 2018 aaha diabetes management guidelines for dogs and cats ellen behrend, vmd, phd, dacvim, amy holford, vmd, dacvimy, patty lathan, vmd, dacvim, renee. Continue to repeat 10 units subcut and poc blood until blood glucose is less than 300 mgdl, then resume normal poc blood sugar check and insulin regular sliding scale. Slidingscale versus basalbolus insulin in the management. Basal insulin is best starting insulin choice for most patients if fasting glucose above goal. Diabetes record for patients taking insulin breakfast lunch supper bedtime other comments. All insulin available in the united states is manufactured in a laboratory, but animal insulin. Mashfiqul hasan phase b resident department of endocrinology bsmmu 2. Insulin injection resources tip sheets on insulin injection best practices we created a series of tip sheets for diabetes care and education specialists to use when assisting their patients with understanding how insulin. Mixed insulin is more likely to cause hypoglycemia8,19 and generally requires a fixed meal schedule8. Getting started on novolog flexpen a discreet, prefilled, dialadose insulin pen please see additional important safety information on next page. Current intensive insulin regimen for type 2 diabetes. Sliding scale regular or humalog insulin uw health. Sliding scale regular humulin insulin physician order set.
Developed by the diabetes coalition of california, october 2010 see web site. Stepwise dosing and titration of insulin for type 2 diabetes in the ambulatory setting update 52010. Your health care team may have given you this information as part of your care. Patient instructed humalog insulin lispro is a fastacting insulin that starts to work about 15 minutes after injection, peaks in about 1 hour, and keeps working for 2 to 4 hours. Apr 12, 2020 spanish, low literacy pdf very low literacy pdf general diabetes patient education handouts through a partnership with home diagnostics, a producer of glucometers, the acu has created new patient education materials focused on diabetes for a low literate and multicultural population. Little kid for example, johnny usually takes 12 nph6 regular before breakfast and 5 nph2 regular before dinner. These earlier studies used urine glucose for sliding scale, but with demonstration of inaccuracy of urine glucose 3, blood glucose replaced urine glucose for sliding scale in diabetic.
In most sliding scale insulin therapy regimens, your blood sugar is taken using a glucometer. In the slidingscale method, the dose of insulin to be taken is based on your blood sugar level, just before your meal. Started in 1995, this collection now contains 6767 interlinked topic pages divided into a tree of 31 specialty books and 732 chapters. Insulin sliding scale dose blood sugar low dose moderate dose high dose 60 110 no insulin no insulin no insulin 111 150 2 units 4 units 6 units 151 200 4 units 8 units 10 units 201 250 6 units 10 units 12 units 251 300 8 units 12 units 15 units 301 350 10 units 14 units 18 units. Apr 05, 2019 sliding scale insulin therapy is one way a person with diabetes can work out how much insulin to take before a meal without causing negative effects on the body. Although its use is not recommended, sliding scale insulin. This patient information booklet is not intended to be exhaustive and should. Continue to repeat 10 units subcut and poc blood sugar checks every 30 minutes until blood glucose is less than 300 mgdl, then resume normal poc blood sugar check and insulin aspart sliding scale. Single dose of insulin that combines either rapidacting or shortacting and intermediateacting insulin in a fixed ratio. Most people who take humalog use a sliding scale or take a certain dose routinely throughout the day. The sliding scale method does not accommodate changes in insulin needs related to snacks or to stress and activity. Errors and poor outcomes with sliding scale insulin dosing studies demonstrate, and experts agree, that there is little evidence for using only sliding scale insulin to control blood glucose. If patient unable to do multiple daily injections, consider switching to mixed insulin instead of adding prandial insulin.
The bolus insulin is based on the blood sugar level before the meal or at bedtime premixed. For information about the sort evidence rating system, go to org afpsort. Humalog sliding scale insulin coverage blood sugar result humalog insulin coverage subq 60 124 no coverage 125 150 2 units of humalog insulin subq 151 200 4 units of humalog insulin subq 201 250 6 units of humalog insulin subq 251 300 8 units of humalog insulin subq 301 350 10 units of humalog insulin subq. Humalog sliding scale insulin coverage blood sugar result humalog insulin coverage subq 60 124 no coverage 125 150 2 units of humalog insulin subq 151 200 4 units of humalog insulin subq 201 250 6 units of humalog insulin subq 251 300 8 units of humalog insulin subq. Sliding scale insulin regimens for type 2 diabetes. If you are on a sliding scale, results of your blood sugar check tells you how much insulin to take.
Insulin orders for patients with type 2 diabetes order set. Patients in a mixed medicalsurgical icu were compared during two 9 month periods. Sliding scale insulin refers to a treatment regimen that provides no basal insulin and. Table 1 provides additional potential indications for iv insulin infusion. Novolog sliding scale insulin chart photos of novolog sliding scale insulin. Guide to starting and adjusting insulin for type 2 diabetes. Injection is usually taken 2 times per day with breakfast and dinner. Type 2 diabetes mellitus is a chronic, progressive disease characterized by multiple defects in glucose metabolism, the core of which is insulin resistance in muscle, liver, and adipocytes.
The first is for a younger child, and the second is for an older child. Please practice handwashing and social distancing, and check out our resources for adapting to these. Do not change the type of insulin you use unless told to do so by your healthcare provider. Stepbystep patient injection guide becton dickinson. It is difficult to 9obtain optimal control without occasional, mild episodes of hypoglycemia. A nomogram for intravenous insulin infusion in critically ill patients was evaluated in a retrospective beforeafter cohort study. Novolin 7030 novoelin 70% nph, human insulin isophane suspension and. Diabetes facts 2012 and guidelines 2011 yale school of medicine. Refer to diabetes education clinic for insulin education upon discharge. You take the same longacting insulin dose no matter what the blood glucose level. Sliding scale insulin regimens for type 2 diabetes using multiple daily injections. In the sliding scale method, the dose of insulin to be taken is based on your blood sugar level, just before your meal. Diabetes patient handout pdf doctor for sugar diabetes salmon and type 2 diabetes scarborough centre for healthy communities diabetes sanatogen protein drink diabetic.
Insulin injection resources tip sheets on insulin injection best practices we created a series of tip sheets for diabetes care and education specialists to use when assisting their patients with understanding how insulin works and teaching proper injection technique, whether using a syringe, pen, or pump for delivery. Novolog mix 7030, novolin mix 7030, humalog mix 7525, humulin. The sliding scale method is more precise than fixed dose insulin in that it takes account of the fact that peoples blood glucose is not always in the normal range before meals. Patient was educated on slidingscale insulin therapy as follows. Oct 7, 2014 insulin drug chart for nursing printable sliding scale insulin chart stay safe and healthy. All insulin available in the united states is manufactured in a laboratory, but animal insulin can still be imported for personal use. Nph insulin has elevated risk of hypoglycemia so use with extra caution6,8,15,17. Sliding scale requires a bit more patient investment than fixed dose, as you might imagine. Insulin helps your cells use the sugar and other carbohydrates you eat for energy. Some people also take it if blood sugars are high at bedtime.
The general principles of sliding scale therapy are. Getting started on levemir flextouch flextouchthe only prefilled insulin pen with no pushbutton extension1 accurate dosing from 1 to 80 units1 works with novo nordisk pen needlesa large, clear dosing window endofdose clickb prefilled with 300 units of levemir low injection force push button1. Normal blood glucose and insulin levels over 24 hours. Below are two examples of an insulin sliding scale. If the premeal blood sugar is high, you take higher dose of insulin. Acu and the nurse practitioner healthcare foundation announce the release of 40 educational handouts for patients who are starting insulin.
Sliding scales are less effective in covering a premeal high blood sugar, because the high blood glucose correction and food bolus cannot be split. Sliding scale insulin therapy is one way a person with diabetes can work out how much insulin to take before a meal without causing negative effects on the body. The sunnybrook diabetes education sundec program, offers group. These earlier studies used urine glucose for sliding scale, but with demonstration of inaccuracy of urine glucose 3, blood glucose replaced urine glucose for sliding scale. Insulin sliding scale dose blood sugar low dose moderate dose high dose. The provider or staff performing the teaching should check off each item as it is completed to document teaching. Sliding scale insulin regimens approximate daily insulin requirements. Veterinary practice guidelines 2018 aaha diabetes management. Stepwise dosing and titration of insulin for type 2 diabetes in the ambulatory setting.
Consider using a basalbolus and supplemental correction insulin regimen. National subcutaneous insulin charts australian commission. Administer 12 units subcut, notify provider, and repeat poc blood sugar check in 30 minutes. Adjust insulin dose every 3 days until bg sliding scale depending on sensitivity. Optimizing glucose management in hospitalized patients using. Correction insulin corrects or lowers high blood sugars before meals. Insulin drug chart for nursing printable sliding scale.
Administer 12 units subcut, notify provider, and repeat poc blood sugar check in 1 hour. Basal insulin is best starting insulin choice for most patients. The dose doesnt take into account how much insulin a patient needed in the past, nor does it consider how sensitive a patient has been to its effects. Started in 1995, this collection now contains 6767 interlinked topic pages divided into a tree. Divide the total carbohydrates by the insulin to carbohydrate ratio. Jul 16, 2012 adapted from guide to starting and adjusting insulin for type 2 diabetes, 2008 international diabetes center, minneapolis, mn.
Guide to starting and adjusting insulin for type 2 diabetes cadth. Insulin, given either intravenously or subcutaneously, is the preferred regimen for effectively treating hyperglycemia in the hospital. Healthcare professionals are advised to use clinical discretion and consideration of the circumstances of the individual patient when using the chart to manage bgls. An understanding of different insulin s, their action and safe dose adjustments a step by step approach is provided to teaching your patient the basics about starting insulin.
Reviews diabetic complications both ones that develop rapidly acutely or slowly chronically how to recognize them, and what to do if they occur. Each handout is written in easy to understand language with simple illustrations. The higher your blood glucose the more insulin you take. Diabetes facts 2012 and guidelines 2011 yale school of. National subcutaneous insulin charts and resources national subcutaneous insulin chart for acute hospitals. This is done about four times a day every five to six hours, or before meals and at bedtime. Stepwise dosing and titration of insulin for type 2. Administer 14 units subcut, notify provider, and repeat poc blood sugar check in 1 hour.
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