Tuesday September 26, 2006
INSLUIN SLIDING SCALE

Patients in the ICU with hyperglycemia should be managed by protocolized insulin infusion. However, when patients are improving, and ready to be discharged from the ICU, insulin sliding scale is a very common switch over. A few important points to remember on the insulin switch over!

a) Each unit of insulin decreases the blood glucose level by 30 – 50 mg/dl.

b) Type 1 and type II patients have different insulin requirements. Type 1 patients require less insulin (about 0.5 U/kg/day) than type II’s (1.0 U/kg/day and up depending on resistance). Remember type 1 patients need basal insulin even when NPO (i.e. approximately 1/2 - 1/3 their usual dose).

c) Think about basal insulin levels with long acting insulins such as NPH, glargine, or ultralente.

d) For BG less than 80 mg/dl, give a patient that can take PO’s 20 grams of fast acting carbohydrate (6 oz. fruit juice or soda, 4 glucose tabs, or 12 oz. low fat milk). If the patient cannot take PO’s, give 25 cc of D50 IV push. Check the finger stick glucose q15 minutes until BG more than 100 mg/dl.

e) May need to decrease doses in renal failure (insulin is not as rapidly cleared).

f) May need to increase doses for patients who are septic or treated with steroids (insulin resistance).

g) Patients on TPN/PPN may need an insulin drip (insulin can be added to TPN).

h) On the floor, Mild hyperglycemia is better than hypoglycemia.



Related previous pearl: IV insulin dose


The best precise article we found with all insulin related protocols is
Hospital management of diabetes: Beyond the sliding scale written by Dr. Etie Moghissi, Co-chair, American College of Endocrinology Task Force on Inpatient Diabetes and Metabolic Control. ( Reference: CLEVELAND CLINIC JOURNAL OF MEDICINE VOLUME 71: NUMBER 10 OCTOBER 2004. Page 801).