Table of Contents

INSULIN SUBCUTANEOUS SLIDING SCALE (Adapted from General Medicine)

 1. Give scheduled insulin subcutaneously (i.e. Regular, NPH, etc)

 

2. Measure capillary blood glucose and for signs/symptoms or hypo- or hyperglycemia

    o ac meals & qhs  if eating or on bolus tube feed - DEFAULT

    o q6h (06-12-18-24) if on continuous tube feed or TPN

    o q4h (04-08-12-16-20-24) if NPO       

 

3. Give insulin Regular (R) sliding scale subcutaneously:

    o TID ac meals (NOT qhs)  - DEFAULT

    o  as per frequency of glucose check per # 2 above (i.e. ac meals & qhs, q6h or q4h)

 

Bedtime insulin Regular sliding scale may be considered for patients who are eating or on bolus tube feed

NOTE: Most patients are NOT given bedtime regular insulin due to risk of overnight hypoglycemia)

  • If regular insulin is given at bedtime, administer HALF of indicated dose. Recheck capillary blood glucose at 0300

 

Blood Glucose

mmol/L

Low Insulin Resistance

Intermediate Insulin Resistance

High Insulin Resistance

< 4

Follow Hypoglycemia Protocol

4.1-8

0 units

0 units

0 units

8.1-10

0 units

0 units

2 units

10.1-12

0 units

2 units

4 units

12.1-14

2 units

4 units

6 units

14.1-16

4 units

6 units

8 units

16.1-18

6 units

8 units

10 units

18.1-20

8 units

10 units

12 units

> 20

8 units & call MD

12 units & call MD

14 units & call MD
       

 

4. Call MD if any of the following:

  • patient becomes NPO; tube feeding or TPN initiated or stopped

  • persistent nausea/vomiting; change in level of consciousness

  • glucose < 4 or > 16 mmol/L on 3 consecutive measurements or at same time of day on 3 consecutive days