Insulin Sliding Scale

Use this sliding scale as an example only
Adjust per patient weight and activity or Disability
1. Type I Diabetes Mellitus = 0.6 - 0.7 u/kg/d
2. Type II Diabetes Mellitus = 0.3 u/Kg/d

Reactive approach to Blood Sugar control
1. Delays Insulin until Hyperglycemia appears
Does not meet Basal insulin requirements
Promotes large swings in Glucose control

Basal insulin should not be eliminated
1. Applies even to those not eating
2. Lantus should be continued at usual dose
3. NPH Insulin
  1. AM dose: 50% of usual dose
  2. PM dose: 100% of usual dose
Estimate sensitivity using "rule of 1800"
1. BG change per unit Insulin = 1800/total Insulin daily
2. Example of 60 units/day: 1 unit drops BG 30 mg/dl
Protocol (uses rapid acting Insulin, e.g. Lispro)
1. Goal Blood Glucose is <150
2. Using sensitivity, how many units to drop 50 mg/dl
  1. For example above, ~1 unit to drop BG 50 mg/dl
    1. BG 150-199: 1 unit Bolus Insulin (regular or RA)
    2. BG 200-249: 2 units Bolus Insulin
    3. BG 250-299: 3 units Bolus Insulin
    4. BG 300-349: 4 units Bolus Insulin
    5. BG Over 350: 5 units Bolus Insulin
  2. Add in coverage for meal intake
    1. Based on per Carbohydrate when Glucose >60 mg/dl
    2. Use for Type I Diabetes, consider for Type II
    3. Add to sliding scale coverage above
    4. Add 1 unit Insulin per Carbohydrate
    5. Example: For 3 Carbohydrate meal, add 3 units