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)
What is sliding scale insulin therapy?
Sliding scale therapy refers to an insulin administration regimen. 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.
General principles of sliding scale insulin therapy are as follows:
- You need to take the pre-set amount of carbohydrates at each meal.
- Pre-mixed insulin doses are based on pre-meal blood sugar levels.
What are the disadvantages of sliding scale insulin therapy?
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.
What precautions to take while on sliding scale insulin therapy
If you have been put on sliding scale insulin therapy, you need to have a consistent lifestyle. Precautions 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 carb at the same time every day.
- Do not change the intensity, duration, or frequency of exercise.
Moreover, insulin can be taken in other ways. Check with your doctor to determine which regimen suits you the best.
What are other types of insulin regimens?
Apart from sliding scale insulin therapy, your doctor may recommend one of the following methods of taking insulin:
- 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.
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Kitabchi AE, Nyenwe E. Sliding-scale insulin: More evidence needed before final exit? Diabetes Care. 2007 Sep;30(9):2409-2410.
Sliding Scale Therapy. https://dtc.ucsf.edu/types-of-diabetes/type2/treatment-of-type-2-diabetes/medications-and-therapies/type-2-insulin-rx/sliding-scale-therapy/
Patient education: Type 1 diabetes and diet (Beyond the Basics). https://www.uptodate.com/contents/type-1-diabetes-and-diet-beyond-the-basics