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Forum Name: Diabetes

Question: Regular schedule and sliding scale


 regina_walker - Fri Feb 10, 2006 5:16 am

Why do we have the sliding scale?why was it invented?What kind of Insulin is used in the sliding scale and why?

Can a patient have a regular scheduled dose of insulin in addition to a sliding scale?

If a patient has a Blood sugar of 98 do you give the regular scheduled Insulin? Or if Blood sugar is low ( below normal range ) would you still go ahead and give scheduled dose ?
 Dr. N. Haider - Sat Feb 11, 2006 2:39 am

User avatar hi,

Diabetes, like every life-long disease, requires a close liasion between the physician and the patient.

In answering your questions, you need to know two basic facts:

1. The damage in diabetes is due to uncontrolled hyperglycemia (raised blood glucose)

2. The insulin dose and diet of the patient have been properly worked out by the physician and the patient. So, as long as the patient follows his diet chart, he will not get extremely deviated from normal range of glucose.

Having said that, the sliding scale was used to get an estimate of what units of insulin patient requires. Say, for example the random glucose is 360, now the insulin dose was worked out to bring it down to near-normal.
But the damage has already been done. The high glucose has contributed its bad effects.
The fixed dose insulin uses a standard units/kg schedule to start on, which is later individualized for each patient. This results in a much better glycemic control. The patient seldom has raised glucose.

The sliding scale is still used in surgical units and ORs for short term treatment of diabetes just before or after surgery.

The type of inulin used in sliding scale is Regular insulin.

Usually, it is best to follow the fixed dose plan. Dual plans are used normally when switching over to fixed schedule or to achieve a better control in a hospital setting.

Answering your second query, if the value of blood glucose is low, you should still administer insulin IF this is a pre-meal reading, as a positive shoot is going to happen in 30 minutes!

The regular insulin is to be avoided if this was a bed time reading.

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