What type of glucose control do you have at your hospital, if any?

[ethyl]

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Do you see a lot of sliding scale used alone? Does basal+sliding scale predominate? Is there any pharmacy monitoring of glucose levels too?

One of my preceptors would find hyperglycemic general inpatients with glucose levels always >150, add up their past 24 hours of bolus insulin and convert 50-75% of the total to basal insulin for the next day. Is this the "correction dose" method or something else?

 

[bigpharmD]

50-75% thats a lil extreme....

we usually do lantus with ss insulin

 

[aboveliquidice]

lantus with ss insulin

+ 1

We have Levemir for long acting as well - but I am yet to see it dosed... Mostly Lantus and Lispro.

 

[njac]

I believe the term "sliding scale" isn't being used as much these days - that implies more chasing the tail of an already high glucose.

We do Lantus with "correction doses" of Aspart prior to meals. We have an insulin order set with preset values, as low dose, medium and high.

 

[ethyl]

50-75% thats a lil extreme....

we usually do lantus with ss insulin

How do you adjust their basal if their glucose is consistently elevated?

I've asked 3 clinical pharmacists and got 3 different answers.
The first one I already mentioned. They added up the entire day's worth of sliding scale insulin units , multiplied it by 50-75%, and added that amount to the basal insulin for the next Qdaily dose.

A second pharmacist said she prefers to first add scheduled short acting boluses, leave the basal dose alone and continue sliding scale. If there's no response a day after the scheduled short acting bolus, then add more lantus.

Another pharmacist prefers to add up all of the patient's daily insulin (including basal and bolus insulin), multiply it by 80%, and use 50% of the result as the basal dose and 50% divided up into 3 scheduled bolus doses.

After looking at literature all last night, I've yet to find a 'for sure' guideline supported method for adjusting insulin for general inpatients. 🙁

 

[bigpharmD]

I usually do the basal as about 25-30% of their 24 hour needs if i am just starting then add ss

I am a fan of adding small boluses prior to meals (4-6 units) so your not chasing your tail all day.

 

[johnep34]

In UK movement is towards Lantus and Levemir to provide a baseline. Novorapid or Actrirapid then used at mealtimes. Frees pt from tyranny of having to eat at set times.

Glucose meters are sold very cheaply $3 - $15 or given away at initial diagnosis. The state then pays for the testing strips. Some pts test 5-6 times a day, even with type 2 diabetes.

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