Humalog is used to improve blood sugar control in adults and children with diabetes mellitus. Use this sliding scale as an example only adjust per patient weight and activity or disability delays insulin until hyperglycemia appears cover as units per glucose 50 mgdl over 150 mgdl renal failure insulin 50% renal excreted v. Diabetes sliding scales and insulinglucose infusion. Im a newly diagnosed lada diabetic, less than a month. As sliding scale insulin therapy has fallen out of favor, many experts recommend using basal insulin with mealtime insulin added when needed. See insulin infusion pump system labeling to determine if insulin lispro can be used with the pump system. Humulin r sliding scale chart best picture of chart. The goal of insulin therapy is to keep your blood sugar levels within a target range.
Most patients have two orders for insulin administration. Check pump labeling to ensure the pump has been evaluated with insulin lispro. Sliding scale therapy approximates daily insulin requirements. Give supplemental insulin lispro following the sliding scale protocol 1d for blood glucose 140 mgdl. Longacting insulin glarginedetemir or nph, once or twice a day with short acting insulin aspart, glulisine, lispro, regular. Use of a standardized protocol to decrease medication errors. Glycemic control with regular versus lispro insulin. Slidingscale insulin therapy ssi in the slidingscale method, the dose is based on your blood sugar level just before your meal. This is a reactive way of managing hyperglycemia and should not be used as the sole means of controlling blood glucose unless absolutely necessary. Because at night only the amount of insulin needed to cover the snacks before going to bed. Insulin is usually injected in the fat under your skin.
In the hospital, it is best to give when meal tray is in front of patient or immediately after eating if it is unclear whether the patient will. Historically, sliding scale regular insulin was the issue now rapid acting insulins are a concern. Insulin is a hormone that works by lowering levels of glucose sugar in the blood. A c the sole use of sliding scale insulin in the inpatient hospital setting is strongly discouraged. First described in 1934, what physicians typically refer to as slidingscale insulin ssi is fast or rapidacting insulin only, given subcutaneously, typically at meal times and sometimes bedtime, but only when blood glucose is above a threshold e. Adapt protocol to glycemic targets, changes in medication, and changes in nutrition. The lower your blood sugar, the loser the insulin dose. Correction insulin sliding scale, supplemental, bolus. Insulin lispro u100 humalogr may be diluted with insulin diluting medium for humalog to provide concentrations of u10 or u50. These protocols are designed to be given independent of nutritional intake. The example sliding scales are for regular insulin with blood glucose bg measured in mgdl. Sliding scale regular humulin insulin physician order set.
Oral agents for diabetes were held upon admission and patients were followed throughout their hospital stay. Transitioning safely from intravenous to subcutaneous insulin. Arbitrary sliding scale insulin should be avoided as it is not only. Cats rarely received the prescribed daily dose due to rate adjustments based on the sliding scale loosely following macintire use of lispro insulin for treatment of diabetic ketoacidosis in dogs. Subcutaneous insulin sliding scale protocol uk diabetestalk. Sliding scale insulin therapy involves creating and following an individual chart.
Dosing depends on the patients level of insulin resistance. Insulin therapy is a critical part of treatment for people with type 1 diabetes and also for many with type 2 diabetes. Administer 12 units subcut, notify provider, and repeat poc blood sugar check in 30 minutes. So, you will be covering the patient with 4 units of lispro based on their blood glucose of 215 mgdl. Diabetes management intermediate acting insulin humulin n. The higher your blood sugar, the more insulin you take. 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.
Sliding scale insulin refers to a treatment regimen that provides no basal insulin and provides only short acting insulin if needed according to blood glucose test results. The other order is a sliding scale that starts at 150. Lispro goal blood glucose is insulin regular or ra. Longacting insulin glarginedetemir or nph, once or twice a day with short acting insulin aspart, glulisine, lispro, regular before meals and at bedtime longacting insulin glarginedetemir or nph, given once a day regular and nph, given twice a day. 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.
If a patient is able and expected to eat all, give supplemental lispro insulin before each meal and at bedtime following the usual column. Just a quick question regarding insulin administration. Sliding scale insulin ssi is commonly used to manage hospitalized patients with and without diabetes mellitus. An insulin regimen with basal, nutritional, and correction components is the preferred treatment for patients with good nutritional intake. Take humalog insulin sliding scale chart 10 units of humalog before meals and. The physician has ordered insulin lispro humalog to be given before meals per sliding scale. Insulin sliding scale protocol australia diabetestalk. Diabetes sliding scales and insulinglucose infusion during. Using sliding scale to determine insulin dose youtube.
Learn about testing and managing low blood sugar, including possible causes, symptoms, and treatment for low blood sugar hypoglycemia. If transitioning off of iv insulin infusion, see step 2 of chart, call pharmacy for assistance, utilize the insulin drip calculator, andor reference transition from iv to sq insulin protocol. Mar 15, 2015 transitioning safely from intravenous to subcutaneous insulin. This study supports the adoption of a protocoldirected insulin infusion sliding scale as a standard of care for postcardiac surgery. Sliding scale insulin regimens approximate daily insulin requirements.
Nclex practice question on insulin registered nurse rn. The transition from intravenous iv to subcutaneous sq insulin in the hospitalized patient with diabetes or hyperglycemia is a key step in patient care. Management will be individualised according to treating endocrinologist preference and may involve intravenous insulin infusion, subcutaneous basal insulin with supplemental insulin sliding scale or insulin pump therapy. The protocoldirected insulin infusion sliding scale is a safe and effective method. Sliding scale insulin protocol follow ssi reference text medications medication sentences are per dose. The standing order for one of our patients is as follows. Insulin, given either intravenously or subcutaneously, is the preferred regimen for effectively treating hyperglycemia in the hospital. Protocoldirected insulin infusion sliding scales improve. Slidingscale insulin regimens when administered alone were associated with a threefold higher risk treatment of type 2 diabetes mellitus in the older patient view in chinese administered immediately after a meal to better match the meal size and minimize hypoglycemia. Inpatient diabetes management endotext ncbi bookshelf. Fortythree patients with type 2 diabetes, who were taking oral agents only, were admitted to a medical inpatient service and randomized to receive either regular or lispro insulin sliding scale. Longacting insulin glarginedetemir or nph once or twice a day with short acting insulin aspart, glulisine, lispro, regular before meals and at bedtime. Glycemic control in hospitalized patients not in intensive.
Designing an insulin regimen diabetes education online. Longacting insulin glarginedetemir or nph, once or twice a day with short acting insulin aspart, glulisine, lispro, regular before meals and at bedtime. Sliding scale insulin ssi, a treatment regimen that. So, even if the patients not eating, if you check a blood glucose level and its elevated, give correction insulin if npo give. In slidingscale insulin therapy, the dose is based on your blood sugar level. Insulin types vary depending on how quickly they work, when they peak, and how long they last. If you have been using a sliding scale, another way to make insulin dose adjustments is to add all of the sliding scale doses the patient has been given to the previous tdd and then recalculate the 5050 lantushumalog split based on the new tdd. Optimizing glucose management in hospitalized patients using. Consider endocrinediabetes consult for diabetes management and education. I take my insulin in the am pm, i was on humalog with meals 20 units and.
Quick reference 1 2019 version novolog mix 70 30 dosing medication errors humalog mix25 25 insulin lispro rdna low sliding scale insulin chart poskin humalog kwikpen sliding scale chart poskinhumalog kwikpen sliding scale chart poskininsulin dose ration algorithm for lm50 50 or lisproprescribing 75 25 and 50 mi humaloginpatient diabetes management endotext ncbi. Basal insulin is intended to keep blood glucose levels under control during periods of fasting or sleep. As slidingscale insulin therapy has fallen out of favor, many experts recommend using basal insulin with mealtime insulin added when needed. 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. Optimizing glucose management in hospitalized patients. If targets are not being met, insulin doses should be titrated by 10% to 20%. Correctional subcutaneous sliding scale insulin to be administered indicate frequency. Sliding scale regular insulin dc oral antidiabetic drugs on admission starting total daily dose tdd. 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. Use insulin lispro in accordance with the insulin infusion pump systems instructions for use. Adult sliding scale for insulin aspart novolog umc health system. You will need to calculate a total daily dose if needed.
Do not expose insulin lispro in pump reservoir to temperatures 98. Basal insulin should not be stopped, even if patient is npo lantus, levimir and sometimes nph if md orders. Longacting insulin glarginedetemir or nph, once or twice a day with short acting insulin aspart, glulisine, lispro, regular before meals and at bedtime longacting insulin glarginedetemir or nph, given once a day regular and nph, given twice a day premixed, or shortacting insulin analogs or regular and. Its only job is to correct an elevated glucose level. Learn sliding scale insulin with free interactive flashcards. Use rapidacting insulin aspart, lispro, or glulisine or shortacting insulin regular. Insulin for gestational and pregestational diabetes. Sliding scale insulin ssi, a treatment regimen that has been around since the. In this video, you will learn how to use the correction factor and insulin to carb ratio on a sliding scale to determine how much insulin to give with a meal. Intravenous insulin glucose infusion for labour preferred management option consult with endocrinologist prior to use. May 01, 2010 the sliding scale for insulin dosage that is based on levels of glycosuria was introduced in 1934,10 and the technique was gradually adapted to blood glucose measurements. Insulin protocols for managing dka critical care veterinary.
Umc adult sliding scale insulin orders patient label here insulin sliding scale dose blood glucose mgdl low dose moderate dose high dose 400 mgdl and mean blood glucose concentrations decreased following protocol. Jan 24, 2020 quick reference 1 2019 version novolog mix 70 30 dosing medication errors humalog mix25 25 insulin lispro rdna low sliding scale insulin chart poskin humalog kwikpen sliding scale chart poskinhumalog kwikpen sliding scale chart poskininsulin dose ration algorithm for lm50 50 or lisproprescribing 75 25 and 50 mi humaloginpatient diabetes management endotext ncbi shelfinsulin dosage. 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. Sliding scale regular or humalog insulin uw health. Also giving a sliding scale for her bolus, humalog is an outdated way of dosing. A c a hypoglycemia management protocol should be adopted and implemented. Blood glucose control is improved when compared with the conventional practitionerdirected insulin infusion sliding scale. Admelog, humalog insulin lispro dosing, indications.
This page includes the following topics and synonyms. Find out how it works and learn about problems with this diabetes. Apr 08, 2019 sliding scale therapy approximates daily insulin requirements. To see if you are eligible, find your family in the table below. Longacting insulin glarginedetemir or nph once or twice a day with short acting insulin aspart, glulisine.
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. Change insulin in the reservoir at least every 7 days. Humalog insulin lispro insulin sliding scale moderate dose, qid, ac and hs, 340 12 units and call md. Based on insulin sensitivity estimate sensitivity using rule of 1800 bg change per unit insulin 1800total insulin daily. This is done about four times a day every five to six hours, or before meals and at bedtime. Bg change per unit insulin 1800total insulin daily. This may reduce the need for snacks which may contribute to increased weight gain. Choose from 49 different sets of sliding scale insulin flashcards on quizlet.
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