Insulin Sliding Scale Protocol for Type II Diabetic Patients

Not recommended for more than two (2) days as the only method of control

Regimens:
 Low Dose Regimen: Suggested as starting point for the thin and elderly
 Medium Dose Regimen: Suggested as starting point for average weight
 High Dose Regimen: Suggested as starting point for overweight patients
 Very High Dose Regimen: Suggested as starting point for patients with infections or
those receiving steroids
Insulin Type:

Regular Insulin Rapid Acting Insulin (Humalog, Novolog)*

Frequency of Monitoring: AC & HS Q 6 H (12 MN, 6 AM, 12 N, 6 PM)

(If patient is NPO or on
continuous tube feeding)
Protocol:
1. If Potassium is low (< 3.5 mEq/L), call M.D.
2. Advance to next higher dose regimen if glucose level is > 250 two (2) times in 24 hours and all
readings were > 100.
3. Decrease to the next lower dose regimen if glucose level is between 60 and 100 twice in 24
hours.
4. Physician should complete a new sliding scale protocol order sheet with dose regimen changes
and send a copy to pharmacy.
Glucose Medium Very High
Level Low Dose Dose High Dose Dose
(mg/dL) Regimen Regimen Regimen Regimen Other
Serum Hypoglycemia Hypoglycemia Hypoglycemia Hypoglycemia
FBS < Protocol and Protocol and Protocol and Protocol and
60 Call MD Call MD Call MD Call MD  
60-150 0 0 0 0  
150-200 0 2 4 6  
201-250 3 6 8 10  
251-300 4 8 12 14  
301-350 6 10 14 18  
351-400 9 12 16 22  
9 Units and 12 Units and 16 Units and 22 Units and
> 400 call MD call MD call MD call MD  

*Recommended
Patient Demographics

________________________ _____
PHYSICIAN SIGNATURE DATE
MEC Nov. 2002
1. General
1. Use this sliding scale as an example only
2. 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
2. Disadvantages of Sliding Scale Insulin
1. Reactive approach to blood sugar control
1. Delays Insulin until hyperglycemia appears
2. Does not meet basal Insulin requirements
3. Promotes large swings in glucose control
3. Protocol: Summary
1. Cover as units per glucose 50 mg/dl over 150 mg/dl
2. Adjust per condition
1. Lower doses
1. Low weight Type I Diabetes Mellitus
2. Renal Failure (Insulin 50% renal excreted)
2. Higher dose
1. Large Type II Diabetes Mellitus
2. Corticosteroid use
3. Sepsis or severe illness
4. Protocol 1: Based on Insulin sensitivity
1. 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
2. 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
3. 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
5. Protocols: Sliding Scales
1. Very low schedule (Insulin-sensitive)
1. BG 150-199: 0.5 unit bolus Insulin (regular or RA)
2. BG 200-249: 1 units bolus Insulin
3. BG 250-299: 1.5 units bolus Insulin
4. BG 300-349: 2 units bolus Insulin
 5. BG Over 350: 2.5 units bolus Insulin
2. Low schedule
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
3. Medium schedule
1. BG 150-199: 2 unit bolus Insulin (regular or RA)
2. BG 200-249: 3 units bolus Insulin
3. BG 250-299: 5 units bolus Insulin
4. BG 300-349: 7 units bolus Insulin
5. BG Over 350: 8 units bolus Insulin
4. High schedule (Insulin-resistant)
1. BG 150-199: 3 unit bolus Insulin (regular or RA)
2. BG 200-249: 4 units bolus Insulin
3. BG 250-299: 7 units bolus Insulin
4. BG 300-349: 10 units bolus Insulin
5. BG Over 350: 12 units bolus Insulin