Sliding Scale Insulin treatment

By jsd2005 Latest Reply 2009-03-26 11:27:36 -0500
Started 2009-03-26 08:27:16 -0500

Sliding scale insulin is a method of treatment mostly for type 1 diabetics, but during acute illness may be used for type 2 also. it is relatively easy to follow. However, don't use this method unless your Dr. agrees!

It is a method to fine tne your insulin requirements and normalize your blood sugar levels.

For instance at mealtimes, your prescription for regular insulin may look something like this. Most sliding scales involve regular insulin.

X Units for blood sugar less that 180
Y Units for 181-240
Z Units for 241-320
XY Units for 321-400
YZ for sugars greater than 401

Take the insulin 1/2 hour before you eat. Humalog is taken 15 minutes before a meal.

This is a way to manage sugars before you eat and 2 hours after you eat. normally, you check your sugar right before you eat which determines the sliding scale dose you will use.
Always check your sugars after eating and at bedtime. Hopefully this will get things under control and you can go back to your regular regime once feeling better.

15 replies

kdroberts 2009-03-26 09:51:33 -0500 Report

To me, this kind of sliding scale is kind of pointless because it doesn't take into consideration what you are eating. It's all well and good saying "take X units if blood sugar is less than 180" but what happens if you are eating A carbs and need 5X of insulin to cover those carbs? By using this sliding scale you've just taken 1/6 of the insulin you needed and could end up in serious trouble. On the flip side, if your blood sugar is 300 and you eat very few carbs you could end up injecting way more than you need and also end up in serious trouble.

I have no problem using this type of scale as a secondary compensation scale but especially if you are taking a mealtime insulin then you should really be looking at a insulin:carb ratio first and then using the above sliding scale to compensate when your blood sugar is high. You may also find that your I:C ratio and sliding compensation scale changes depending on the time of day.

For example, if your I:C ratio is 1:10, you eat 30g carb and your blood sugar is 200 then you would take 3+Y units of insulin based on the scale above and your I:C ratio.

Also, Humalog shouldn't blindly be taken 15 minutes before a meal. It should be taken within 15 minutes of eating, during or immediately after eating. It may be different meals require different timings and your pre-meal blood sugar may also play a part in when to take it. I know that for me I get the best results if I take Humalog 10 minutes before breakfast, immediately before I eat lunch and 5 minutes after dinner.

John Crowley
John Crowley 2009-03-26 09:58:01 -0500 Report

Our doctor shared an interesting study with us the last time we were in to see him. He said that for users of fast acting insulin, taking the insulin 10 minutes before eating resulted in a 1% improvement in A1c. The only exception of course is if you are experiencing low blood sugar. Then you need to start eating first to bring up the blood sugar and then take the insulin.

And about your point of correction dosages vs. meal dosages, you are right on. In fact, with my son, we always try to treat the high blood sugar first and delay eating. Well, unless we're having an omelet or something that is virtually carb-free.

kdroberts 2009-03-26 10:00:43 -0500 Report

That study sounds interesting. Do you happen to know where I can read it, the name or anything that I could search for it with?

John Crowley
John Crowley 2009-03-26 10:49:20 -0500 Report

I can't locate the study our doctor referred to. But we see him again next week, so I will ask him for the reference. (I did find one that might be the study but it's in a journal that only allows access to paid members.)

But I did run across this study that has some interesting relevance to our discussion.

Apparently, Sanofi Aventis has been looking at a simpler dosing structure than carb counting and insulin to carb ratios. The study sounds like their simplified version performed very well in the study.

Anyway, food for thought.

alwaystryin 2009-03-26 11:27:36 -0500 Report

As a newbie (somewhat) to cargegiving for my Wife with T1, she was put on the Scale for novolog. My dilemma is utilizing the 450/500 rule along the the Scale. This point you make of the 'cart before the horse' is right on, as far as the Scale, and carb per insulin ratio's. Is my confusion based on my lack of knowledge of how the Insulin Sensitivity factor impacts these equations?

LadyDi - 26259Miller
LadyDi - 26259Miller 2009-03-26 09:33:36 -0500 Report

Good information, but the objective of the "Discussion" topic is to encourage a discussion between members. Posting portions of articles and then asking a question, etc., can promote discussion. But the others are right in that something like this is best utilized if posted in the "News & Articles" section. Thanks for the information, however.

Also discussed previously was the issue of copyright infringement. In the "News & Articles" area it allows you to give credit appropriately to the source of the information.

Anonymous 2009-03-26 09:16:56 -0500 Report

Clinical information should be posted under news and articles, not too long ago this was brought up after other members were posting such things as discussions and not as news and articles, perhaps you should re-read that discussion so you know where to put clinical information vs. your own personal opinions.

jsd2005 2009-03-26 10:28:32 -0500 Report

I am still getting use to this site. If that seems a more appropriate place then I will post there. I'm only trying to present information that I will hope others. From the discussions I've read these are topics people want information on.

MeiMei 2009-03-26 09:06:51 -0500 Report

This is the way I control my type 1 along with Lantus at night. Hopefully, your doctor has prescribed this method and you have been to a diabetic nurse teacher to have the amount regulated.

Anonymous 2009-03-26 09:00:18 -0500 Report

Hi, it's anonymous. I found this same information on an internet search. Any of us can find this information. Not very hard to cut and paste it.

jsd2005 2009-03-26 10:26:34 -0500 Report

I don't cut and paste. As a Nurse of twenty two years, i have dealt with this on numerous occasions. I speak from experience, having worked in acute care most of my life.
At least I have the knowledge and background to support my research. What is your problem?

Historically, I disliked sliding scale as it seemed reactive rather than proactive, but it has it's merits. ie. acute illness, stress etc…

kdroberts 2009-03-26 10:43:49 -0500 Report

Well, it may not be a copy and paste word for word but your post looks very much like an article about sliding scales on The example scale you use is identical to the one they use but theirs uses A, B and C instead of X, Y and Z and the general flow, info and style is very, very similar.