Lantus insulin glargine, a longacting insulin is used for treating type 1 q. Highlights of prescribing information hyperglycemia or. Choose from 49 different sets of sliding scale insulin flashcards on quizlet. If i do use a sliding scale, i want them to have a low threshold to call me. Its a great resource if you need affordable medical treatment and dont know where to go. Administer 14 units subcut, notify provider, and repeat poc blood sugar check in 30 minutes. Insulin dosing calculator and insulin titration toujeo. They are usually injected about 10 minutes before mealtime. Correction insulin sliding scale, supplemental, bolus. Learn sliding scale insulin with free interactive flashcards.
Each insulin monomer containing two chains, a 21 residues and b 30 residues, linked by two disulfide bonds. Counting carbs and dosing sliding scale novolog things. Long acting lantus yes toujeo levemir tresiba biphasic insulin novomix 30 no humalog mix 25 or 50 humulin m3 no some insulins should be continued whilst on a gki or insulin infusion see table 1. Blood glucose level target blood glucosecorrection factor units insulin to be given example. If anything needs to be altered, cross out all of that scale and sign for the appropriate scale. Long or intermediate acting insulins are used to mimic the steady background release of insulin and should be continued even when the patient isnt. Chapter 21 adjusting the insulin dosage and thinking scales hours, the evening nph or lantus given at it is important to emphasize that sliding. Should be customized to match insulin sensitivity for each patient. When using a sliding scale, eat the same amount of carbohydrate at each meal. Oncedaily insulin glargine versus 6hour sliding scale regular insulin for control of hyperglycemia after a bariatric surgical procedure.
Lantus is not recommended for the treatment of diabetic ketoacidosis. Stop the vriii and treat the hypo cbg sliding scale is also taken twice daily, when the blood glucose is over 100 mgdl in order to bring the blood glucose back to 100 mgdl within 4 to 5 hours. Shortacting insulin dose humalog novorapid apidra fiasp blood sugar. Dispensing insulin w sliding scale student doctor network. Should insulin be withheld when nothing by mouth is. She is starting me on sliding scale due to my low carb intake, and likely just learning curve issue. Learn about how to start appropriate t1dm and t2dm patients on lantus.
Sliding scale insulin chart dosage sliding scale insulin therapy healthline in sliding scale insulin therapy the dose is based on your blood sugar level find out how it works and learn about problems with this diabetes treatment image result for sliding scale insulin chart dosage what is an insulin sliding scale chart an insulin sliding. Continue to repeat 10 units subcut and poc blood until blood glucose is less than 300 mgdl, then resume normal poc blood sugar check and insulin regular sliding scale. That being said, i tend to manage the glucose of my patients relatively tight. It is for most folks a 24 hour insulin dose and is not to be used to bring down an elevated bg in a short time period. Capitals indicate lifethreatening, underlines indicate most frequent. Insulin is used as a drug to control insulindependent diabetes mellitus diabetes mellitus, type 1. Optimizing glucose management in hospitalized patients. Adult sliding scale for insulin aspart novolog umc health system.
Insulin pens and needles must never be shared between patients. Based on weight or total daily insulin requirement ahrq 2012 sliding scale refers to a set amount of insulin administered for hyperglycemia without regard to the timing of food, presence or absence of preexisting. Seventythree faculty members, 1 residents, and 191 nurses from four hospitals completed a 20. Lantus glargine or levemir detemir or nph insulin a1c greater than 7% with optimal long acting basal insulin.
Pdf insulin glargine in gastrostomy feeding researchgate. Glycemic control in hospitalized patients not in intensive. Mixed insulin is more likely to cause hypoglycemia8,19 and generally requires a fixed meal schedule8. The concentration of insulin glargine in toujeo is 300 units per ml. If a patient develops hypoglycemia, the sliding scale of lispro insulin should be decreased from insulin resistant to usual scale or from usual to sensitive scale. Basal insulin lantus insulin or the subcutaneous insulin pump is usually effective in. Your lantus dose should be about 40% 50% of your total daily dose of insulin. Doctors give trusted answers on uses, effects, sideeffects, and cautions. Guide to starting and adjusting insulin for type 2 diabetes cadth. To work with importing pdf data autocad 2021 autodesk. Lantus, the recommended initial lantus dose is 80% of the toujeo dose that is being discontinued. Historically, sliding scale regular insulin was the issue now rapid acting insulins are a concern. These are one of the newest classes of insulins and work more quickly than the shortacting insulins. I found n to be too unpredictable so i was glad to switch to lantus when it came out.
Pdf insulin glargine is a long acting novel recombinant human insulin analogue indicated to improve glycemic control, in adults and children with type. Recent developments now allow us to focus on the underlying metabolic abnormality ketonaemia, which simplifies the treatment of those who present with modest elevation of blood glucose but with acidosis secondary to ketonaemia euglycaemic diabetic ketoacidosis. Insufficient knowledge of insulin contributes to errors in its use that may cause adverse patient outcomes. I frequently use long acting insulins, usually lantus, for their basal insulin requirements, and then either a supplemental if i know theyre going to eat well or a sliding scale. Sliding scale regimens may include a bedtime high blood sugar correction. Lantus is indicated to improve glycemic control in adults and pediatric patients with type 1 diabetes mellitus and in adults with type 2 diabetes mellitus. Stepwise dosing and titration of insulin for type 2. A recommended sliding scale is on the back of the nsw adult subcutaneous insulin prescribing chart. A basalprandial dosing option for nonintensive care. Oncedaily insulin glargine versus 6hour sliding scale. Continue to repeat 10 units subcut and poc blood sugar checks every 30 minutes until blood glucose is less than 300 mgdl, then resume normal poc blood sugar check and insulin aspart sliding scale.
Guidelines for insulin management for adult diabetics with. Limitations of use lantus is not recommended for the treatment of diabetic ketoacidosis. Evidence for the effectiveness of sliding scale insulin is lacking after more than 40 years of use. Modify insulin regimens only under medical supervision. Metformin 500mg 3 per day glyburide 5mg twice per day levemir 2530 sliding scale insulin carvedilol 12. Monitor blood glucose in all patients treated with insulin. If patient unable to do multiple daily injections, consider switching to mixed insulin instead of adding prandial insulin. Consider insulin scale adjustment if cbg are persistently above 12. Administer 14 units subcut, notify provider, and repeat poc blood sugar check in 1 hour. Lantus is not an insulin that you would use a sliding scale or an evening bg reading to help dose. Native insulin is a globular protein comprised of a zinccoordinated hexamer. This dose reduction will lower the likelihood of hypoglycemia see warnings and precautions 5. Optimizing glucose management in hospitalized patients using a. Can lantus be used as a sliding scale with my current insulin of.
Sitagliptin group discontinue oral antidiabetic drugs or lowdose insulin on admission. As the nighttime scale only considers the amount of insulin required to drop your blood sugar level back into the target range, it should not be used to cover a bedtime snack. For billing purposes, are we supposed to bill days supply as if they got 200uday. Her instructions are to start with 10 units lantus in the pm, and then bolus w novolog, though she appeared amenable to whatever i wanted to try if it wasnt harmful. Use the interactive dosing calculator for dosing your type 2 patients with diabetes on.
How to properly scale an image or pdf after inserting into autocad. If a patient is fasting, specify that the sliding scale is to be given q6h and not before meals. Minich on counting carbs and dosing sliding scale novolog. If changing from a treatment regimen with an intermediate or longacting insulin to a. Sliding scale insulin therapy is one way a person with diabetes can work out how much insulin to take before a meal without causing negative effects on. Longacting insulin glarginedetemir or nph, once or twice a day with short acting insulin aspart, glulisine, lispro, regular. After inserting an image or importing a pdf file, often time the objects and dimensions will not show their true length being that the image is.
The recommended starting dose of lantus in patients with type 2 diabetes who are not currently treated with insulin is 0. Stepwise dosing and titration of insulin for type 2 diabetes in the. Despite persistent expert recommendations urging its abandonment, the use of sliding scale insulin remains pervasive in u. Lantus is actually best when given at the same dose both morning and evening, not using a sliding scale there are other insulins that use the sliding scale but we know of another group that advocates the use of a sliding scale with lantus that they. Chapter 21 adjusting the insulin dosage and thinking scales. Sliding scale coverage usually begins after blood glucose 11 mmoll 200 mgdl if coverage is needed q4hr for 24 hr, then base insulin dose is adjusted first. What regular insulins can be continued alongside a gki or. Type 2 diabetes adult outpatient insulin guidelines if postmeal glucose levels 180. Inpatient diabetes treatment has become more complicated recently with the introduction of new insulin formulations and a new emphasis on tight blood glucose control. Dosing lantus insulin glargine injection 100 unitsml. Humalog sliding scale insulin coverage blood sugar result humalog insulin coverage subq 60 124 no coverage 125 150 2 units of humalog insulin subq 151 200 4 units of humalog insulin subq 201 250 6 units of humalog insulin subq 251 300 8 units of humalog insulin subq. One may need to adjust the amount and timing of short or rapidacting insulins and dosages of any oral antidiabetic drugs. Glycemic control in hospitalized patients who are not in intensive care remains unsatisfactory.
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