Hospital sliding scale insulin protocol

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Sliding Scale. 1500 Rule for Regular Fall in glucose for each 1 unit increase = 1500 "÷ total daily dose of insulin; 1800 Rule for Lispro Fall in glucose for each 1 unit increase =
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 The prescriber must first select the insulin order, and then enter the dose for the selected insulin.  Ensure correct date and time entered.  Nursing staff will document the administered insulin dose and BGL, and this will be recorded in MAR, MAR Summary and Diabetes-Endocrine Interactive Viewband
SSI, sliding scale insulin; basal, basal insulin alone; basal bolus, combination with nutritional or short-acting insulin, both alone or in combination with SSI. The oral medication order form lists oral diabetes agents grouped by class and includes prechecked orders to hold certain medications when the patient is fasted and, in the case of the ... placed on a sliding scale insulin (SSI) protocol. Freedman also indicated that other patients were often placed on a sliding scale protocol because it was a method that was passed down from trainee to trainee as an easy, “auto-pilot” way to treat dia-betes in the hospital, a method that would limit the
Historically, sliding scale Regular insulin was the issue now rapid acting insulins are a concern: 40% of aspart insulin is still around at 3 hours. Need a minimum of 4 hours between SQ doses. Correction insulin (sliding scale, supplemental, bolus). Problems Dosed too frequently. Ordered doses too high. Often no basal insulin ordered.If using sliding scale to estimate insulin needed in hospital: calculate number of units of insulin needed in last 24hrs and either make 100% basal Lantus or make 60% prandial aspart (split over 3 meals) and 40% basal Lantus (at night) VRIII has now replaced the term ‘sliding scale’ as it provides a less ambiguous and clearer indication of what is involved. 19,20 This insulin infusion is almost always accompanied by an IV fluid which contains glucose to prevent hypoglycaemia. 19 The advantage of VRIIIs are that they pro­vide a tightly controlled target blood glucose so improving the clinical out­come, as highlighted above. 19
Sliding scale insulin is frequently used as the sole method of glucose control in the hospital. Its intent, however, is to ‘correct’ hyperglycemia. The ADA now refers to it as ‘correctional’ insulin. The ADA recommends that it should NOT be used as monotherapy for more than 24 hours. It is a retroactive treatment. A patient must have an The bolus insulin is based on the blood sugar level before the meal or at bedtime; Pre-mixed insulin doses are based on the blood sugar level before the meal; Disadvantages of the sliding scale regimen: The sliding scale method does not accommodate changes in insulin needs related to snacks or to stress and activity.
were implemented hospital-wide in June 2016 to replace the previous insulin sliding scale orders. These orders have been recently revised and simplified for ease of use. A. Insulin Subcutaneous Orders for Patients Who are Eating Meals or are NPO (PPO # 717, pages 3-4) Target Blood Glucose : • To maintain fasting capillary blood Correctional insulin (also known as sliding scale or as needed insulin) was allowed as part of any insulin regimen above. Correctional insulin was only recorded when it was unaccompanied by a scheduled insulin. Any basal insulin day: Any day in which intermediate‐acting or long‐acting, scheduled insulin was given. Basal insulin alone day
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