Stupid T2DM/Insulin Question

[Lests55]

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Regarding Sliding Scale Insulin:

If you give a 4 shot regimen in the hospital

1/4 daily dose with AM meal
1/4 d dose with noon meal
1/4 d dose with PM meal
1/4 d dose of NPH at bedtime

....are you giving EXTRA insulin with the sliding scale on top of all of this?

Thanks

 

[JustPlainBill]

Regarding Sliding Scale Insulin:

If you give a 4 shot regimen in the hospital

1/4 daily dose with AM meal
1/4 d dose with noon meal
1/4 d dose with PM meal
1/4 d dose of NPH at bedtime

....are you giving EXTRA insulin with the sliding scale on top of all of this?

Thanks

I'm not quite sure I understand your question....it sounds like you're deviating from the standard 2/3 & 1/3 dosing and trying to weave an understanding of sliding scale on top of that...

From what I've experienced (and I won't go into details as that is different with each institution) SSI is usually given TID with meals to cover CBG spikes while you're titrating the dose of basal.

Please do NOT take this as medical advice or practice advice, just what I've experienced.....

Ask your friendly pharmacist if you're not sure....

 

[All4MyDaughter]

We typically see 1/2 TDD given as basal (either Lantus/Levemir at bedtime or NPH in the 2/3 AM 1/3 PM configuration) and 1/2 TDD given as rapid acting mealtime coverage (Novolog, Humalog or Apidra).

You can incorporate a sliding scale into that mealtime coverage by having the nurse test the patient's BG before the meal. If it's elevated you have them give whatever the scheduled mealtime dose is (to cover the food that will be consumed) plus additional units to get the BG to an acceptable level, based on the patient's ISF.

For example: the regular mealtime dose might be five units of Apidra. If the patient's blood glucose (premeal) is 200 mg/dL and their ISF is 25, you might have the nurse give them an additional two or three (or whatever) units of Apidra to get their blood glucose down before they eat.

Hope this makes sense. A bit fried from studying for board exams.

 

[jdh71]

my usual recipee has been to give half of the total daily dose of insulin as lantus, and the other half as aspart divided in three even doses with meals

or alternatively in most diabetics if you do not know a total daily dose, you can give 10 Units of lantus at bedtime, and 3 units of aspart with meals without worrying about dropping sugars to low. adjust the insulin as need according to the accuchecks

a correction scale can be given over the top with meals as mentioned before

remember you need like THREE solid days on a lantus/levimere dose to know how it's going to work accurately. you can very easily titrate the long acting insulin too aggressively while in the hopsital and end up dropping them low after d/c.

a little high blood sugars never hurt anyone acutely, low on the other hand . . .