What is a Sliding Scale

mbudzi

Well-Known Member
Messages
92
I have Googled this and what I have found doesn't make sense, can someone explain?

It seems to be a method used when diabetics are in hospital. It looks like it sets the insulin does based upon BG. However I can't get clear whether the insulin is Long Acting/Intermediate or Short Acting.

Assuming its Long Acting - is this then just the same as a two dose regime that would be used at home? In which case, where dose the BG testing come into setting the insulin levels.

Confused :crazy: :?
 

sammyk

Member
Messages
18
My husband was recently in hospital for a week and he was put onto an insulin pump. They mentioned sliding scale but not too sure what they meant. I do know though that the pump admisistered insulin per hour and was adjusted as needed and they cheked his blood sugar every hour. Dont know if this helps any

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Ambersilva

Well-Known Member
Messages
715
Type of diabetes
Type 1
Treatment type
Insulin
I was put on a sliding scale when I was admitted to hospital for the initial treatment by Intravenous cannulation to:

Correct fluid loss with intravenous fluids
Correct hyperglycemia with short acting insulin
 

phoenix

Expert
Messages
5,671
Type of diabetes
Type 1
Treatment type
Pump
I think it's a confusing term because it has several slightly different meanings though I suppose they are based on the same principle ie varying insulin according to glucose levels.

When you read about it in the UK especially on forums I think that it's often referring to a method used in hospitals. (as Ambasilva did)

This is a regime where they normally use regular short acting insulin like actrapid. The insulin is given by intravenous infusion. The amount that is given decided by the persons glucose level.
The insulin may be administered together with saline when the glucose level is above a certain level and glucose solution below

The term is also used to refer to varying doses of injected insulin in accordance with the glucose levels. (with no basal)

The term isn't recommended in the UK anymore

Recommendation 20 – Sliding scales The term ‘sliding scale’ should not be used to refer to variable rate intravenous insulin infusions or to predefined subcutaneous insulin boluses according to the prevailing blood glucose. Furthermore, the subcutaneous ‘sliding scale’ is not an appropriate method for controlling unstable diabetes as it can result in alternating hypo and hyperglycaemia in the absence of a basal insulin
Safe and Effective use of Insulin in Hospitalised Patient (NHS)

but you will still find lots of protocols for it's use intravenously
http://www.icid.salisbury.nhs.uk/Clinic ... sulin.aspx
but in this case they also say that basal insulins should be continued and that subcutaneous sliding scales shouldn't be used.

When I was diagnosed in France I wasn't put on a sliding scale . I had 'mild' DKA. They used an insulin pump with a reducing basal plus boluses for meals. I had a saline drip for a brief time .

I was however put onto a sliding scale therapy; yet another slightly different meaning
This is where you take a basal and adjust the mealtime insulin on the basis of the pre meal glucose levels. Carb levels are pre set. It's also a reactive method and requires a very regimented lifestyle, as described here.
http://dtc.ucsf.edu/types-of-diabetes/t ... e-therapy/
 

viviennem

Well-Known Member
Messages
3,140
Type of diabetes
Type 2
Treatment type
Other
Dislikes
Football. Bad manners.
What worries me is that a nurse friend of mine said that they automatically put every diabetic on to this equipment. Is it appropriate for a well-controlled Type 2 in "normal" (ie, non-emergency) hospital situations?

Viv 8)
 

phoenix

Expert
Messages
5,671
Type of diabetes
Type 1
Treatment type
Pump
I think there must be times when they have to use intravenous insulin and when they also have to use saline, glucose and other intravenous solutions . ( but it doesn't necessarily mean that they are being used with a chase the glucose, sliding scale )
you still find ones like this one here used for :
Concurrent illness – vomiting/nil by mouth
Pre major surgery
Post myocardial infarction
During labour for gestational, pregnant ladies with
diabetes
Management of hyperglycaemia in ITU
http://www.rcht.nhs.uk/DocumentsLibrary ... llDocs.pdf
I hope that they don't always use the standard prescription , the doses seem very high to me, if I wasn't eating and if I ate then they wouldn't necessarily be enough for the meal.
From what I read, a sliding scale of insulin is according to many, very outdated and tends to keep glucose levels higher than optimal.
Which is why you can find lots of papers with titles such as
Sliding Scale, time to stop sliding
It's time to abandon the sliding scale ?
Sliding scale use Myth or Insanity?
Sliding scale insulin, will the false idol finally fall?
(this last one gives a brief history of it's use and why it's outdated )
http://onlinelibrary.wiley.com/doi/10.1 ... 231.x/full
 

Sid Bonkers

Well-Known Member
Messages
3,976
Type of diabetes
Type 2
Treatment type
Diet only
Dislikes
Customer helplines that use recorded menus that promise to put me through to the right person but never do - and being ill. Oh, and did I mention customer helplines :)
When I was admitted to hospital at diagnosis I was put on what they referred to as an insulin drip, an intravenous drip that gave me insulin and I assume saline, it couldnt have been all insulin as they changed the bottles several times a day!!

I was kept on it over night to bring my bg levels down from 29 mmol/L and the next afternoon got a visit from a very helpful SDN who instructed me on all things insulin/diabetes/diet/portion control/exercise/alcohol etc etc. She actually talked to me for a good couple of hours and then came back the next day and showed me how to inject myself, it was at this time the drip was removed and I took over my own control and was discharged.

I assume the intravenous insulin would have been based somehow on my weight and bg levels, they were taking my bg levels every hour for the first 24 hours, a right pain as I was woken up every hour, sliding scale perhaps?
 

Sammeh5678

Active Member
Messages
35
A sliding scale is when I have even in Hospital with DKA. You obviously have saleene fluids. The sliding scale is hourly / bi-hourly BG tests and then the nurse will change the dosage of insulin. It's the slow and safe way of bringing te high BG level down.


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David147

BANNED
Messages
93
Type of diabetes
Parent
Treatment type
Insulin
Diabetics take their own blood sugar at specified times, and use a chart to determine how much insulin they should take. It is used for diabetics who are not in control of their blood sugars, those who are, those that are type one diabetic, and type two.
It is one of the most accurate ways to control blood sugar, except to have a insulin pump.
Diabetics can "cover" the meal they just ate, and the system takes things like stress and illness into consideration, both of these can cause blood sugars to rise out of normal range, as can eating too much, or exercising too little.
If you want to learn more, go to the American Diabetic Association website. It is easy to navigate around in, and written in plain english [and Spanish].