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Sliding Scale Insulin Therapy

Insulin is the foundation of treatment for numerous people with diabetes. However, your body either can’t produce enough insulin or can’t use insulin efficiently, If you ’re a diabetic.

People that have type 1 diabetes, and some that have type 2 diabetes, have to take several injections of insulin each day.

The insulin keeps blood sugar in a normal range and prevents high blood sugar situations. This can help avoid complications. The quantity of insulin you should take can be determined in several different ways:

Fixed-dose insulin

With this system, you take a certain set quantity of insulin units at each meal. For instance, you may take 6 units at breakfast and 8 at supper. The figures don’t change based on your blood sugar readings or the quantity of food you eat.

While this may be easier for people just starting insulin, it doesn’t account for pre-meal blood sugar situations. It also doesn’t factor in the varying quantities of carbohydrates in a given meal.

Sliding scale insulin

Carbohydrate to insulin ratio

In this system, you take a certain quantity of insulin for a certain quantity of carbohydrates. For instance, if your breakfast carb to insulin ratio is 101 and you eat 30 grams of carbohydrates, you would take 3 units before breakfast to cover your meal.

This system also includes a “ correction factor” that accounts for your pre-meal blood sugar. For instance, let’s say you want your blood sugar to be under 150 mg/ dL before food, but it’s at 170.

Still, you would take 1 added unit of insulin before your meal, If you ’ve been told to take 1 unit of insulin for every 50 you ’re over. While this takes a lot of practice and knowledge, people who can manage this system can keep better control of their post-meal blood sugar situations.

Sliding scale insulin therapy (SSI)

In the sliding scale insulin system, the dosage is predicated on your blood sugar situation just before your meal. The higher your blood sugar, the added insulin you take.

sliding scale insulin therapy has been an option since the 1930s. It’s most frequently used in hospitals and other healthcare establishments because it’s easy and accessible for the medical staff to administer.

sliding scale insulin has come controversial in recent times because it doesn’t control blood sugar very well.

How sliding scale insulin therapy works

In most sliding scale insulin therapy routines, your blood sugar is taken using a glucometer. This should be calculated approximately four times a day (every 5 to 6 hours, or before meals and at bedtime).

The quantity of insulin you get at mealtime is predicated on your blood sugar results. In majority of cases, fast- acting insulin is used.

Sliding scale insulin

Issues with sliding scale insulin therapy

Experts have raised a number of issues about using sliding scale insulin therapy. They include:

Poor blood sugar control

An article was published in the American Family Physician took a look back at approximately 40 years’ worth of studies on the sliding scale insulin system.

It discovered that no study clearly showed SSI was effective at controlling blood sugar, indeed though many medical center cases were given this system. Rather, SSI frequently leads to a rollercoaster effect.

Also, SSI isn’t truly effective at lowering high blood sugar. Occasionally it can cause blood sugar to dip too low. That may be why studies have shown that people using this system frequently have longer medical center stays than if they were given fixed insulin dosages. .

No personalization

sliding scale insulin therapy doesn’t take into account individual factors that can affect your blood sugar and insulin requirements. individual factors include:

  • Diet: What you eat will affect your body’s needs for insulin. For instance, if you eat a meal that’s high in carbohydrates, you ’ll need a larger dosage of insulin than if you ate a low-carbohydrate meal.
  • Weight factoring: A person who weighs more may need additional insulin. However, the person weighing 180 pounds may not get enough insulin to lower their blood sugar, If a 120-pound person and a 180-pound person each get the same dosage
  • Insulin history: The dosage doesn’t account for how much insulin you ’ve required in the past. It also doesn’t consider how sensitive you ’ve been to insulin’s effects.

Doses reflect current insulin needs

With SSI, you get a dosage of insulin that’s predicated on how well your former dosage of insulin worked. That means the dosage isn’t based on the quantity of insulin you might actually need for this meal.

Still, it may have brought your blood glucose within its target range, If you were given a fast- acting dosage of insulin with lunch. But this may lead to too little insulin being used for your coming meal.

Occasionally the dosages are given too close together or stacked, which causes their effects to overlap.

Sliding scale insulin therapy today

Numerous associations, including the The Society for Post-Acute and Long-Term Care Medicine and the American Geriatrics Society, don’t recommend that hospitals, nursing homes, and other healthcare establishments use sliding-scale insulin therapy.

Rather, they recommend using basal insulin, with mealtime insulin added as required. Basal insulin involves long- acting insulin injections that help keep insulin situations steady throughout the day.

Added to this are fast- acting mealtime insulin and correction dosages to regulate blood sugar situations after meals.

Hospitals and other healthcare establishments appear to be listening to these recommendations — presently, they ’re using SSI therapy less frequently than previously.

Some experts say that sliding-scale insulin therapy should be phased out altogether. But one report from the American Diabetes Association says further investigation still needs to be done.

The report calls for further studies to compare sliding scale insulin with other insulin regimens before medical professionals make the final verdict.

You ’ll likely only encounter sliding scale insulin therapy if you ’re admitted to the hospital or another healthcare establishment. Ask your medical professional about how your insulin delivery will be administered while you ’re there, and what options are available to you.

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