Sliding scale INSULIN is still used

byMahitab Hany, BS Pharm, PGDipClinPharm, PGDipClinNutrition - last updated
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Sliding scale insulin is still giving patients a ride on the blood glucose roller coaster especially when used without basal insulin. Giving short-acting insulin alone multiple times a day based on blood glucose levels just CHASES glucose, it doesn't CONTROL it. Plus giving regular insulin too often can lead to hypoglycemia. Use a PROACTIVE approach instead and help determine a regimen to meet your patient's needs...

          Basal insulin (Lantus, Levemir, NPH) is the first step. Start with 0.1 to 0.2 units/kg/day. Or calculate the daily dose in the sliding scale and start with 50% as basal insulin. For patients already on basal insulin, add the calculated amount to the existing basal dose and stop the sliding scale. Increase by 5% to 10% weekly until the glucose goal is achieved. Weigh the pros and cons of NPH versus Lantus or Levemir. NPH (Insulatard) works as well, and NOT expensive compared to Lantus. But NPH causes slightly more weight gain and nocturnal hypoglycemia.

Basal Plus is a good next step. Explain to patients that this is basal PLUS short-acting (regular or Actrapid) or rapid-acting (Novorapid, etc) insulin given before ONE meal daily, usually the evening meal. Regular insulin (Actrapid) also costs less and is usually as safe and effective as rapid-acting insulin (Novorapid, Apidra). But use rapid-acting in patients with poor renal function or a history of severe hypoglycemia. Basal Bolus is for motivated patients. Make sure patients are willing to give basal insulin (Lantus) once or twice a day PLUS short- or rapid-acting insulin before each meal and test blood glucose frequently. FOR MORE INFORMATION, get our note "When and how to start insulin for diabetes type 2 in primary care?" and read also, "Adjust insulin in T1DM based on diet".

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