What Types of Insulin Are Used for Sliding Scale Therapy?

Sliding scale insulin therapy types include long-acting insulin, short-acting insulin, and premixed insulin.

Sliding scale therapy (SSI) is a type of insulin dosing scale where insulin is administered based on pre-meal levels of blood sugar. More insulin is administered if blood sugar levels are high, and the dose is reduced if blood sugar levels are near the acceptable range.

Sliding scale therapy is an insulin administration regimen that is no longer recommended as a diabetes therapy.

Many diabetes education programs took aim at creating an understanding of this therapy. They started by explaining the sliding scale insulin definition and went deeper into things like how to use a sliding scale for insulin therapy. This helped people learn how insulin dosing is adjusted.

General principles of sliding scale insulin therapy are as follows:

• You need to eat the pre-set amount of carbohydrates at each meal.
• Pre-mixed insulin doses are based on pre-meal blood sugar levels.
• A sliding scale insulin chart or sliding scale insulin formula is used to find the appropriate dose.

Why is sliding scale insulin no longer recommended?

Sliding scale insulin is no longer recommended because it is ineffective in meeting the body's insulin requirements and inefficient for long-term care. It treats high blood sugar after it occurs rather than preventing it, making it less effective in maintaining stable glucose control over time.

People with type I diabetes and some people with type II diabetes are put on insulin therapy that needs a few to several injections to show its effects.

Since sliding scale insulin therapy is no longer recommended, your doctor may recommend one of the following methods of taking insulin instead:

• Fixed-dose insulin: Your doctor prescribes you a fixed dose of insulin at each meal. This does not change based on your pre-meal blood sugar levels or the amount of carbs you are likely to have in your meal.
• Insulin-to-carb ratio: The insulin-to-carb ratio means you would need one unit of insulin for a certain amount of carbohydrate. For example, if your insulin-to-carb ratio is 1:10, it means you would need 1 unit of insulin for every 10 grams of carbs. If you have your lunch or dinner with 50 grams of carbs, the dose of insulin would be 5 units. The ratio is not the same for everyone, and your own ratio may vary from time to time.
• Basal-bolus therapy: This regimen involves a long-acting insulin (basal) to manage blood glucose levels throughout the day, combined with rapid-acting insulin (bolus) administered with meals to cover carbohydrate intake and prevent postprandial glucose spikes.

It's essential to understand which type of insulin is used for sliding scale therapy, as its effectiveness depends on the type and timing of the insulin.

The types of insulin used for sliding scale therapy include:

• Long-acting insulin (glargine/detemir or neutral protamine Hagedorn)
• Short-acting or rapid-acting insulin (aspart, glulisine, lispro, and regular)
• Premixed insulin (a combination of long-acting and short-acting insulin)

So, while short-acting and rapid-acting insulin are the primary types used in sliding scale insulin therapy, premixed formulations may also play a role in certain regimens.

To know how to use a sliding scale for insulin, we should be aware of the following steps:

1. Measure blood glucose before meals and at bedtime.
2. Use the sliding scale insulin chart to determine the dose.
3. Administer the correct rapid-acting or short-acting insulin.

Caution: Sliding scale insulin should only be used under medical supervision. Never adjust insulin doses on your own without a doctor's guidance, as incorrect dosing can lead to serious complications such as low or high blood sugar.

Sliding scale insulin dosing is based on blood sugar ranges.

The sliding scale insulin formula approach is as follows:

• (Blood glucose - target level) ÷ insulin sensitivity factor = correction dose

Note: This is more common in advanced or personalized care.

Here's a sliding scale insulin chart for a patient who's prescribed lispro insulin:

Controversy regarding sliding scale insulin therapy exists because of doubts about its efficacy in controlling blood sugar levels:

• This method does not consider snacks, stress, and activities that occur during the day while administering insulin.
• You need to count the amount of carbs consumed at each meal.
• The method is not always effective at lowering high blood sugar. Sometimes, sugar levels can drop to extremely low levels.
• Factors such as sensitivity to insulin in the past and weight are not considered when deciding the insulin dose.

If you have been put on sliding scale insulin therapy, you need to have a consistent lifestyle.

Precautions of sliding scale insulin therapy include the following:

• Since sliding scale regimens may include a high dose of insulin at night, do not take advantage of this night-time high-dose administration to have a bedtime snack.
• You can change foods but need to have the same amount of carbs at the same time every day.
• Do not change the intensity, duration, or frequency of exercise.

What is the sliding scale for insulin therapy?

Sliding scale for insulin therapy is a flexible dosing regimen used to correct hyperglycemia rather than prevent it.

Can you use Lantus for sliding scale?

Lantus (insulin glargine) is not appropriate for sliding scale insulin therapy. This is because it is a long-acting basal insulin designed to provide steady, background insulin over 24 hours and does not act quickly enough to correct high blood sugar levels.

What is a sliding scale for Humalog insulin?

A sliding scale for Humalog insulin is a method where you adjust your insulin dose based on your current blood sugar level. The higher your blood sugar, the higher the insulin you need to take to bring it down. This method uses Humalog, a rapid-acting insulin, and is usually taken before meals along with food-related insulin.

The typical sliding scale for Humalog insulin is as follows:

Caution: Only use a sliding scale if it's prescribed by your doctor, as incorrect dosing can cause low or high blood sugar.

Can NovoLog be used for sliding scale?

Short-acting insulins such as NovoLog can be used for sliding scale therapy. It's a rapid-acting insulin that works quickly to lower high blood sugar levels, making it appropriate for sliding scale use.

What is the best time to administer sliding scale insulin?

The best time to administer sliding scale insulin is before meals and at bedtime, typically every four to six hours in hospital settings or before each major meal in outpatient care.

Is there a standard sliding scale for insulin?

There is no universal standard sliding scale for insulin; dosing varies by patient needs, clinical setting, and physician judgment.