What is your opinion of the "sliding insulin scale"?

By realsis77 Latest Reply 2011-10-06 02:09:06 -0500
Started 2010-09-13 15:32:44 -0500

Hello famialy. As you all know I'm on a sliding scale for my insulin. I was doing some reading about the subject and I've read that the problem is its not preventing the high blood gluclose its only treating the high. This made perfect since to me and I wanted your opnion on this I would think it would be better to prevent the high rather than just letting the bg level get high then drop it down. What is your opnions on this. Thanks everyone ..

25 replies

jayabee52 2011-10-06 02:09:06 -0500 Report

With my "Jem" when she was alive, it was not a question of preventing a high, because her BGs often became high when she had to use prednisone or cortisone shots to control her Lupis or RA.

We used 2 different sliding scales, for 2 of the 3 insulins her endo had her on. For our part the sliding scales worked well to get her 300 + BG levels down closer to normal.

Jan8 2011-10-04 06:33:49 -0500 Report

If BG readings are consistantly high you need to call your doc and see a dietition. But a sliding scale is only for highs.If you treat it before a high,you could land into trouble. When I was in the hospital,every time they had to use the scale, my blood G almost disappeared and I could'nt even speak or get up. Now,that is'nt the only complication from sliding scales(even though I wanted one). Sometimes the answer could be a pump. The doc suggested one for me,but I am not ready for that. I just don't want anything attached to my body at this time. Just can't get my head around it. People who use pumps seem to love them.

Debbiejf 2011-10-03 23:43:36 -0500 Report

Since I have as yet not been to an Endo, appt in dec. made last june!, there's still so much I don't know about my diabetes although I have been one for 26 years and on insulin for close to 5 if not more. In the beginning of my introduction to insulin I used the hypodermics with Lantus and another insulin-didn't last long because I had trouble reading the guage so then I was put on the pen-70/30 and I had major drops. I was then put on separate pens-novalog and Levimir. I finally got the sliding scale, though it took me awhile to really figure it out, it works for me as long as I can keep my stress level down (impossible) and manage my foods. Since my 'other half' (not married) eats mostly gummy bears and junk and buys crap for the month it's near impossible to get what I need. Can anyone say 'brick wall'??? My BS stays mostly above 300. I steer away from obvious carbs as potatoes, rice etc. Since I never know what food I'm going to eat I can't know how much novolog I need to take. I take my bs and go by what the scale my pcp gave me but I usually need more later. I know this doesn't make a lot of sense and I apologize. By the end of the day I'm screwed and pumping more novalog in me to get as close to normal as I can, all I can say is COME ON DECEMBER!!!!!!!!!!

r1house 2011-10-03 23:13:55 -0500 Report

I am recently diagnosed (Aug. 2011) Type 2 diabetic also on sliding scale. What I have found to be most helpful for me is I made a copy of my sliding scale label, had it laminated and placed a copy in each of my meter cases and a copy on my refrigerator. Since I am newly diagnosed and my numbers were so high, I knew the most important thing for me was to understand how to get my numbers down. I'm happy to report that after being discharged from the hospital in early August, I only have to take my long acting insulin at bedtime. Carb counting for me has been very confusing, but learning how and what to eat and portions along with exercise. has been much easier. I'm hoping that Carbs counting will be my next goal, especially with the Holidays fast approaching.

Uncle Lew
Uncle Lew 2011-10-03 17:44:30 -0500 Report

You’re right. The biggest problem with a sliding scale it is reactive rather than proactive treatment. Its treats a high blood glucose level rather than prevent. Much damage can be done in letting your blood glucose levels run high before treating them. Most doctors d not recommend a sliding scale regime for that very reason.
Before a meal I use Novolog (a rapid acting insulin) to thwart high glucose levels. Working with my endocronoligist, we have figured out the following system for me.
Breakfast: I calculated the numbers of carbs I will be eating and multiply it by 0.2. The resulting number is the number of units of Novolog I need to take.
Lunch: Again I calculate the number of carbs but multiply it by 0.3 ( a larger factor is needed as I usually consume more carbs at lunch that breakfast). The number is the amount of insulin I need.
Dinner: The multiplier for dinner is 0.4 as I eat my most carbs then.
We have found that this system works well for me in combination with a daily injection of Lantus (a long acting insulin). The Lantus usually prevents any unexpected high glucose levels.
In the case of an unforeseen high level (due to illness or a little unplanned noshing) I use a sliding scale with my Novolog. For glucose levels between 150-200, I take 2 units. For 201-250 I take 4 units. For 251-300 I infect 6 units. And for 301 and above (occurred only once in the last 18 months) I take 8 units. This system has worked real well for me. My last three A1c tests have been 6.2%, 6.3% and 6.1%. I haven’t had an A1c above 6.8% in the last 2½ years.
Take to your doctor about a program that will prevent the highs. You will be better off and your A1c will show it.

margokittycat 2011-08-19 21:43:04 -0500 Report

When your talking about the sliding scale I guess it just depends on the kind of insulin you take. For me I am not able to take long lasting insulin as I am allergic to them. I have been on regular only insulin for over 27 years and have been on a sliding scale ever since. It works well for me(though every diabetic is different). Due to my lack of appetite a lot of times the sliding scale works great. I test at 6 am every morning take a shot on what my appetite and BG is at the time and then do it three more times each day. If stressed or sick I may have to take a couple extra shots during the corse of the day. I will have to look for that book it sound intresting. I have down and it came from my doctor that fast acting insulins actually take your BG down 30 points per every unit. It may also help you to know the more water you drink the more stable your BG will be water esopecially ice cold water flushes your system out and gets rid of excess sugar.

kdroberts 2010-09-14 10:15:50 -0500 Report

I'm not really a big fan of fixed sliding scales for the quicker insulins, I favor an insulin to carb ratio and correction factor. I:C ratio is basically how many carbs can be handled by 1 unit of insulin. So, 1:5 would mean that every 5g of carb you are eating you would need 1u of insulin, 25g of carb = 5u insulin. A correction factor is how much 1 unit of insulin will lower your blood sugar without other factors. So a correction factor of 20 would mean that each unit of insulin would drop your blood sugar 20 points. It's useful when your blood sugar is not where you want it to be. You can use it in addition to I:C ratio when eating kind of like a sliding scale. Say you are eating your 25g of carb, your blood sugar is 140 and you want to end up at 100 you would take the 5u to cover the carb and then 2 units correction to drop the 40 points. It's not always an exact science, well, more often than not really, but it does work, especially with the very fast acting insulins. If you want a good book that helps you understand using insulin and how to figure things out, look for Think Like a Pancreas by Gary Scheiner.

pixsidust 2011-10-03 22:12:58 -0500 Report

I am not on insulin…yet. My grandpa started on Metformin and after 20 years moved to insulin. Should I follow in the same path this is such good info!

jayabee52 2010-09-14 02:11:42 -0500 Report

I personally am on a stable dose of NPH, a moderately long acting insulin (but as I understand not the longest)

When my bride was with me she had 2 sliding scales: #1 for Novolog Aspart (very short acting - with the morning fasting BG - together with a basal dose of NPH) and #2 for Novolin R short acting, but not as short as Aspart (in the afternoon).

I had to keep track of her BG#s and her sliding scales and draw up her needles. I had copied the sliding scales the Endo emailed to me and printed them all on a page which I printed and put in a 3 ring binder which faced the BG and Vitals log for the month. I would then send the V/S & BG readings to the Endo twice a week and if needed he would adjust the sliding scales as appropriate (if you're interested in seeing my log sheet, you might wish to copyand adapt it for your use, please email me via DC email - if you're not my friend, invite me to be your friend)

Her Endo and the visiting nurse were impressed by my system.

I understand Lynette what you're saying. It would seem better to pre-empt the high before it got high. However that might very well lead to over compensating for the carb load and go too low, perhaps even dangerously low. I know that sometimes I will eat the same thing twice and the first time I go sky high, and the 2nd time it doesn't bump the BG# up all that much for some reason. If I was trying to pre-emptively dose myself on the basis of what my BG did with the first, I could give myself a low. Not cool!

I would rather adjust the dose according to a known BG reading than a supposed reading.

I might be all wet, but that's the way it seems to me now.

jayabee52 2011-10-03 18:09:41 -0500 Report

since I had answered this question in Sept 2010 I have discontinued insulin usage and am managing my Diabetes with what I eat alone. No diabetes medications. It is working well for me. My May 2011 A1c was 5.5 and my weight has dropped about 50 lbs

Armourer 2010-09-13 19:27:21 -0500 Report

My numbers have finally been in control the last two months because the DD added carb counting. I was already on a sliding scale, and still am, but have added carb counting too. I was being dramatically under medicated! Carb counting has made a big difference for me!

Anonymous 2011-10-03 08:38:17 -0500 Report

I still have not gotten that carb counting thing right. I take 9 Units of Humaolog before each meal.. how much carbs should support that # of units.. can anyone say? and then at nights I take 14 units of Lantos thats the long lasting insulin… but in the evenings my #s jump up.. the mornings my readings are fairly good from 94-120 . after lunch it jumps. I might be having 2 much ..dont know. I eat mostly fish and vveg and try to include a solid carb like sweet potato… am I doing something wrong here?

Armourer 2011-10-03 20:08:32 -0500 Report

Everyone is different. FOR ME I have a basic humalog injection of 22 units whenever I eat. If my numbers are over 150, I add 2 units for every 50 points (sliding scale). Then I have 1 unit for every 5 carbs I'm eating. Some meals I only inject 26 units, other it can be 80 units. Then Lantus at 55 units twice a day. This is the formula FOR ME.

Type1Lou 2011-10-03 15:40:30 -0500 Report

I don't understand how you cannot factor in the amount of carbs in calculating your meal-time insulin dose. Also, your carb ratio might be drastically different from mine, that's why nobody can say how many carbs YOU would need to warrant 9 units of Humalog. I'm currently using a 20grams carb to 1 unit of Novolog for breakfast and 15:1 for lunch and dinner. If I took 9 units of insulin, I would have to eat 135 grams of carb for breakfast…that's a little more than 5 english muffins! Bottom line, you have to find out how your body reacts to individual foods and determine what works for you…not always easy, I know.

nzingha 2011-10-03 18:16:09 -0500 Report

I just have not gotten it… some days it works perfectly some days it just does not… some times I have to cut back… but i know breads and crackers and oats r not my friends anymore…yet sweet potatoes are great for me. I can eat it 3 times a day and it doesnt spike my sugar…

nzingha 2011-10-03 08:39:35 -0500 Report

oh and i have to have a fruit with every meal as i feel like i have not eaten… that is probably whats causing the jump because i love fruits and nuts and i usually have them for desert.. a small mango and about 8 cashews or almonds for desert

Harlen 2010-09-13 18:00:10 -0500 Report

how can that work ??????
today you take in 130 grams of carbs tomarow you take in 200 grams what do you do ?????
I love my pump lol
best wishes

newbie51 2010-09-13 16:22:40 -0500 Report

I wasa put on a sliding scale but it was so confusing for me that I quit. Now I'm on what is known as a correction(above 150 subtract 120 and divide by 20). That is so much easier for me.

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