i've always been confused about this topic... particularly what is the difference between sliding scale and correction scale (at my hospital there are 2 seperate forms for these 2 insulin protocols)
also is there anything else that i need to keep in mind when dealing with a patient's sugars and insulin on the wards?
Use a drip in the Unit.
For DKA just follow the algorithm found in pocket medicine. Remember initial bolus dose the rate is 0.1 Units per KG, until the
GAP closes, sugars can remain high. Check K often. To reiterate . . . just follow the algorithm.
Sliding scale is probably sort of an insulin only sugar treatment algorithm similar to what they use for the drips only in sub-q form. And the correction scale is what the nurses give to patient already on medications for anything over and above.
After 24 hours of sub-q sliding scale insulin, you should know pretty well how much they will need in 24 hours by adding it up, let's 20 Units in 24 hours. I like to take that number and cut in half (10) and give that as long acting insulin at bedtime (glargine or glitiamer usually, whatever us formulary at your institution . . . OR if money for meds is a problem you can cut your half number in half and give as NPH AM and PM [5 and 5]), and the other half gets given as short acting aspart or regular with meals in three divided doses, ie from out current example 3 Units regular or aspart with breakfast, lunch, and dinner. The 6 am blood sugar will tell you if you need to adjust your evening glargine/glitaimer (or alternative the afternoon NPH, and the afternoon blood sugar will tell you how to adjust the morning NPH if that's th regimine you are using)
Now, you need to hold short acting insulins for NPO status. You're not supposed to need to stop a long acting insulin like glargine or glitiamer for NPO status because these are supposed to control basal sugar metabolism, BUT you'll see people either stopping them altogether or cutting them in half for NPO status.
Think of sulfonylureas like insulins with regard to dosing and the timing of blood sugars - these medications CAN give you hypoglycemia (some are better for liver or kidney disease, so if you have a liver or kidney patient just double check)
Metformin is great first line for newly diagnosed DM2's especially if HgbA1c is <8. Metformin will not give you hypoglycemia (though you will run into
at least one attending who will sear they've seen it). Hold these for IV contrast procedures - even though in it's current incarnation metabolic acidosis is almost unheard of, we all do it. No metformin in chronic kidney guys as a rule, but some will tolerate fine (use will probably be attending specific in this group)
In the even of glucose (or sulfonylureal) overdose that will not respond to D50, use a glucagon drip. In these patients giving more glucose only stimulates further intrinsic insulin response. Do not panic, use the glucagon with D50.
