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Insulin Sliding Scale Dose Chart

Insulin (medication)

Insulin (medication)

"Insulin therapy" redirects here. For the psychiatric treatment, see Insulin shock therapy. Insulin is used as a medication to treat high blood sugar.[3] This includes in diabetes mellitus type 1, diabetes mellitus type 2, gestational diabetes, and complications of diabetes such as diabetic ketoacidosis and hyperosmolar hyperglycemic states.[3] It is also used along with glucose to treat high blood potassium levels.[4] Typically it is given by injection under the skin, but some forms may also be used by injection into a vein or muscle.[3] The common side effect is low blood sugar.[3] Other side effects may include pain or skin changes at the sites of injection, low blood potassium, and allergic reactions.[3] Use during pregnancy is relatively safe for the baby.[3] Insulin can be made from the pancreas of pigs or cows.[5] Human versions can be made either by modifying pig versions or recombinant technology.[5] It comes in three main types short–acting (such as regular insulin), intermediate–acting (such as NPH insulin), and longer-acting (such as insulin glargine).[5] Insulin was first used as a medication in Canada by Charles Best and Frederick Banting in 1922.[6] It is on the World Health Organization's List of Essential Medicines, the most effective and safe medicines needed in a health system.[7] The wholesale cost in the developing world is about US$2.39 to $10.61 per 1,000 iu of regular insulin and $2.23 to $10.35 per 1,000 iu of NPH insulin.[8][9] In the United Kingdom 1,000 iu of regular or NPH insulin costs the NHS 7.48 pounds, while this amount of insulin glargine costs 30.68 pounds.[5] Medical uses[edit] Giving insulin with an insulin pen. Insulin is used to treat a number of diseases including diabetes and its acute complications such as diabetic ketoacid Continue reading >>

How To Initiate And Dose

How To Initiate And Dose

The AACE Algorithm for Adding/Intensifying Insulin starts with the addition of a basal (long-acting) insulin. If glycemic control is not achieved,* treatment may be intensified with a prandial insulin.1 <7% for most patients with T2D; fasting and premeal BG <110 mg/dL; absence of hypoglycemia A1C and FBG targets may be adjusted based on patient's age, duration of diabetes, presence of comorbidities, diabetic complications, and hypoglycemia risk Adapted from AACE/ACE Consensus Statement1 Indications and Usage for Apidra® (insulin glulisine [rDNA origin] injection) Apidra® is a rapid-acting insulin analog indicated to improve glycemic control in adults with type 2 diabetes or adults and children (4 years and older) with type 1 diabetes. When used as a mealtime insulin, the dose of Apidra® should be given within 15 minutes before or within 20 minutes after starting a meal. Apidra® given by subcutaneous injection should normally be used in regimens that include a longer-acting insulin. Important Safety Information for Apidra® (insulin glulisine [rDNA origin] injection) CONTRAINDICATIONS Apidra® is contraindicated during episodes of hypoglycemia and in patients hypersensitive to Apidra® or any of its excipients. WARNINGS AND PRECAUTIONS Insulin pens, needles, or syringes must never be shared between patients. Do NOT reuse needles. Closely monitor blood glucose in all patients treated with insulin. Change insulin regimens cautiously and only under medical supervision. Changes in insulin strength, manufacturer, type, or method of administration may result in the need for a change in insulin dose or an adjustment in concomitant oral antidiabetic treatment. As with all insulin preparations, the time course of Apidra® action may vary by individual or at different times in Continue reading >>

Understanding The Sliding Scale In Diabetes Care

Understanding The Sliding Scale In Diabetes Care

One of the tools physicians use to help people who take insulin keep their blood glucose in control is a sliding scale. There are many reasons your health care provider may prescribe this type of insulin regimen for you but foremost it has to do with how much involvement you are able to have and want to have in figuring out your insulin needs. Some people want to spend as little time and effort as possible with their insulin and are willing to follow a structured, time-bound meal plan. For these folks a fixed dose (taking the same amount of insulin at each meal regardless of their blood glucose level or the type or amount of food they are eating) is a good choice. On the other end of the spectrum is matching insulin to carbohydrate. This requires a strong commitment to carb counting and following a mathematical algorithm at meals. The sliding scale falls smack in the middle. No math to do, meal timing isn’t as important but carbohydrate content at meals does need to be standardized. When people hear the term “sliding scale,” they might picture a balance scale with weights tumbling off one end. Now there is no physical object to slide; rather it is a chart that tells you how much insulin to give yourself at meals based on your blood glucose levels The chart is divided into a series of columns. The column farthest to the left lists blood glucose ranges starting from below 70mg/dl to 400mg/dl or more, increasing in increments of anywhere from 20 mg to 50 mg/dl. The other columns correspond to breakfast, lunch and dinner, and, if necessary, bedtime. The columns may have you take different amounts of insulin at different times of the day at the same blood glucose level. This may be because your sensitivity to insulin changes throughout the day or because your meals ten Continue reading >>

Interactive Dosing Calculator

Interactive Dosing Calculator

Lantus® is a long-acting insulin analog indicated to improve glycemic control in adults and pediatric patients with type 1 diabetes mellitus and in adults with type 2 diabetes mellitus. Lantus® should be administered once a day at the same time every day. Limitations of Use: Lantus® is not recommended for the treatment of diabetic ketoacidosis. Contraindications Lantus® is contraindicated during episodes of hypoglycemia and in patients hypersensitive to insulin glargine or one of its excipients. Warnings and Precautions Insulin pens, needles, or syringes must never be shared between patients. Do NOT reuse needles. Monitor blood glucose in all patients treated with insulin. Modify insulin regimen cautiously and only under medical supervision. Changes in insulin strength, manufacturer, type, or method of administration may result in the need for a change in insulin dose or an adjustment in concomitant oral antidiabetic treatment. Do not dilute or mix Lantus® with any other insulin or solution. If mixed or diluted, the solution may become cloudy, and the onset of action/time to peak effect may be altered in an unpredictable manner. Do not administer Lantus® via an insulin pump or intravenously because severe hypoglycemia can occur. Hypoglycemia is the most common adverse reaction of insulin therapy, including Lantus®, and may be life-threatening. Medication errors, such as accidental mix-ups between basal insulin products and other insulins, particularly rapid-acting insulins, have been reported. Patients should be instructed to always verify the insulin label before each injection. Severe life-threatening, generalized allergy, including anaphylaxis, can occur. Discontinue Lantus®, treat and monitor until symptoms resolve. A reduction in the Lantus® dose may be re Continue reading >>

Adjustable Dosing

Adjustable Dosing

Adjustable Dosing NovoLog® stays in step with your activities and mealtimes. Your health care provider will teach you how to adjust your NovoLog® dose to your eating, activity, and blood sugar levels. NovoLog® is designed to closely mimic your body's insulin patterns at mealtime. It is changed slightly so that it acts more quickly than regular human insulin. That is why it is called analog insulin. Keep in mind, you will need to eat a meal within 5 to 10 minutes after taking NovoLog®. For information on food labels and carb counting, click here. You and your diabetes care team will also have to see how your physical activity affects your insulin dosage and adjust it as needed. For example, when you are very physically active, you have to decide whether to eat more or take less insulin, since both physical activity and insulin decrease the amount of sugar in the blood. Checking your blood sugar often when you are physically active will help you figure out how each type of physical activity you do affects your blood sugar. NovoLog® Dosing Tool Your diabetes care team can help you learn how to fine-tune your NovoLog® doses throughout the day. While you are figuring out how to adjust your insulin dose, you will want to stay in close touch with your diabetes care team. If you are using NovoLog® FlexPen®, you can select doses from 1 to 60 units in 1-unit steps. NovoPen Echo® provides precise half-unit dosing from 0.5 units up to 30 units. It also records the insulin dose and time passed since the last injection. If you have type 2 diabetes, ask your diabetes care team if the NovoLog® Dosing Tool might be right for you. This tool was created to help with adding and adjusting your mealtime insulin dose. If you’ve been taking NovoLog® for a while and your A1C is not Continue reading >>

Insulin Regular Human (rx, Otc)

Insulin Regular Human (rx, Otc)

Dosage Forms & Strengths injectable solution Type 1 Diabetes Mellitus Initial: 0.2-0.4 units/kg/day SC divided q8hr or more frequently Maintenance: 0.5-1 unit/kg/day SC divided q8hr or more frequently; in insulin-resistant patients (eg, due to obesity), substantially higher daily insulin may be required Approximately 50-75% of the total daily insulin requirements are given as intermediate- or long-acting insulin administered in 1-2 injections; rapid- or short-acting insulin should be used before or at mealtimes to satisfy the remainder balance of the total daily insulin requirements Premixed combinations are available that deliver rapid- or short-acting components at the same time as the intermediate- or long-acting component Type 2 Diabetes Mellitus Type 2 diabetes inadequately controlled by diet, exercise, or oral medication: Suggested beginning dose of 10 units/day SC (or 0.1-0.2 unit/kg/day) in evening or divided q12hr Severe Hyperglycemia (Diabetic Ketoacidosis) 0.1 unit/kg/hr IV continuous infusion; if serum glucose does not fall by 50 mg/dL in the first hour, check hydration status; if possible, double the insulin hourly until glucose levels fall at the rate of 50-75 mg/dL/hr; decrease infusion to 0.05-0.1 unit/kg/hour when blood sugar reaches 250 mg/dL Dosing Considerations Dosage of human insulin, which is always expressed in USP units, must be based on the results of blood and urine glucose tests and must be carefully individualized to optimal effect Dose adjustments should be based on regular blood glucose testing Adjust to achieve appropriate glucose control Look for consistent pattern in blood sugars for >3 days Same time each day: Compare blood glucose levels with previous levels found at that time of day For each time of day: Calculate blood glucose range Continue reading >>

Glycemic Control In Hospitalized Patients Not In Intensive Care: Beyond Sliding-scale Insulin

Glycemic Control In Hospitalized Patients Not In Intensive Care: Beyond Sliding-scale Insulin

Glycemic control in hospitalized patients who are not in intensive care remains unsatisfactory. Despite persistent expert recommendations urging its abandonment, the use of sliding-scale insulin remains pervasive in U.S. hospitals. Evidence for the effectiveness of sliding-scale insulin is lacking after more than 40 years of use. New physiologic subcutaneous insulin protocols use basal, nutritional, and correctional insulin. The initial total daily dose of subcutaneous insulin is calculated using a factor of 0.3 to 0.6 units per kg body weight, with one half given as long-acting insulin (the basal insulin dose), and the other one half divided daily over three meals as short-acting insulin doses (nutritional insulin doses). A correctional insulin dose provides a final insulin adjustment based on the preprandial glucose value. This correctional dose resembles a sliding scale, but is only a small fine-tuning of therapy, as opposed to traditional sliding-scale insulin alone. Insulin sensitivity, nutritional intake, and total daily dosing review can alter the physiologic insulin-dosing schedule. Prospective trials have demonstrated reductions in hyperglycemic measurements, hypoglycemia, and adjusted hospital length of stay when physiologic subcutaneous insulin protocols are used. Transitions in care require special considerations and attention to glycemic control medications. Changing the sliding-scale insulin culture requires a multidisciplinary effort to improve patient safety and outcomes. In the United States, the prevalence of diabetes mellitus is now 10.8 percent of adults 20 years and older, and 23.1 percent of adults 60 years and older.1 An estimated one in five U.S. health care dollars is spent caring for someone with diabetes.2 Over the past 10 years, the Agency fo Continue reading >>

Insulin Dosing

Insulin Dosing

OTHER HELPFUL PAGES ACRONYMS AND DEFINITIONS ADA - American Diabetes Association Basal Insulin - Long- and Intermediate-acting insulins used to supply constant blood levels of insulin activity Carb- carbohydrate DM1 - Type 1 diabetes DM2 - Type 2 diabetes FDA - U.S. Food and Drug Administration Hypoglycemia - low blood sugar Multidose insulin regimen - Insulin regimens that involve a basal insulin and a premeal insulin given at meals Premeal Insulin - also called “prandial” insulin. Rapid and short-acting insulins given at mealtime for short burst of insulin. Total daily dose of insulin - Sum of premeal and basal insulin given in a day Units/kg/day - units of insulin per kilogram of body weight per day USDA - United States Department of Agriculture 1 kilogram = 2.2 pounds IMPORTANT POINTS ABOUT DOSING INSULIN Overview There are a number of different ways to dose insulin No detailed guidelines for dosing insulin have been issued by professional associations The appropriate method for individual patients will depend on a number of factors including patient education, patient motivation, diabetes control, and resources Low blood sugar (Hypoglycemia) The main concern in most patients when initiating an insulin regimen is the occurrence of low blood sugars Patients need to understand that when they are starting and adjusting insulin, there is an increased risk for low blood sugars A number of things can affect this risk including variations in eating patterns, sensitivity to insulin, and variations in activity level Measures to help prevent low blood sugars Start low and go slow - patients naïve to insulin should start at the lower end of dosing ranges When using a multidose regimen, adjust only one of the regimens every 3 days and alternate between the two (see below f Continue reading >>

Sliding-scale Insulin: An Ineffective Practice

Sliding-scale Insulin: An Ineffective Practice

By Mark D. Coggins, PharmD, CGP, FASCP Aging Well Vol. 5 No. 6 P. 8 In the United States, approximately 26 million people have diabetes mellitus, including 10.9 million adults aged 65 or older.1 The number of those newly diagnosed with diabetes continues to rise, and the Agency for Healthcare Research and Quality reports that over the past decade there has been a 26% increase in the number of patients discharged from hospitals with a primary diagnosis of diabetes. The overall costs related to diabetes treatment place a tremendous burden on the healthcare system, with one in five US healthcare dollars being spent on the condition. Patients with diabetes typically have medical expenses that are 2.3 times higher than those of nondiabetics,1 and families with a child who has diabetes reportedly spend as much as 10% of their income on the disease.2 Beyond the financial cost, diabetes can have a tremendous negative impact on patients and their families due to associated intangibles that are more difficult to measure, such as pain, depression, anxiety, inconvenience, and a lower quality of life. Diabetes Complications The primary goal of diabetes management is to achieve a level of glycemic control that closely mimics that of nondiabetic patients in an effort to prevent the long- and short-term complications associated with the disease. Inadequate blood glucose control over an extended period of time can result in significant long-term complications affecting multiple organ systems with reduced quality of life and increased mortality and morbidity (see Table 1 below). Short-term complications related to the failure to control glycemic levels can result in symptoms associated with periods of hyperglycemia. Issues related to hypoglycemia, when severe and left untreated, can lead Continue reading >>

Lantus Dosing

Lantus Dosing

Well, I never thought I’d say this, but it’s a great week to be a person with Type 1 diabetes. With all of the bad news surrounding the Type 2 drug Avandia (rosiglitazone), it’s a relief to know I don’t have to worry about it. I recommended you read my colleague Tara’s blog entry (“Type 2 Drug Avandia Linked to Increased Risk of Heart Attacks”) for the full story. That’s one of the first times in my life I’ve referred to someone as a colleague. What can I say? It’s just not a word in my describe-a-friend/coworker vocabulary. While all of the controversy surrounds Avandia, I’m way over in Type 1 land contemplating whether or not to lower my daily dose of Lantus (insulin glargine). I’ve just started a brand new bottle of Lantus and I’ve been taking my normal 15 units in the morning and then eating a rather normal breakfast and lunch, but I’m still going low in the midmorning and early afternoon. This happened Monday after eating Brussels sprouts and whole-wheat pasta for lunch and only taking one unit of rapid-acting NovoLog (insulin aspart) to help out the Lantus. I’ve known for a while that my body is sensitive to insulin, but lately it’s been a little more sensitive than usual. I took 13 units of Lantus yesterday and my blood glucose was 86 mg/dl before lunch. I often wonder how much of an adjustment two units of Lantus is. While I’m very much locked in on an insulin-to-carbohydrate ratio with my NovoLog, it’s a bit tricky to judge how much the longer-lasting insulins affect your blood glucose. Is there a chart for your Lantus dose? I seem to remember something from when I was diagnosed. I wonder what Google will tell me to do. I realize that Lantus doesn’t have a true peak the way some of the other insulins do, but sometimes it su Continue reading >>

Insulin Dosing Made Simple

Insulin Dosing Made Simple

I have found, in my years of practicing correctional medicine, that few practitioners who come to corrections are comfortable with insulin dosing. In my experience, this is especially true for physician assistants and nurse practitioners, but many physicians have problems, too. Insulin dosing can be complicated and tricky at times, but for most patients, 10 simple rules will get you to where you need to be. We first need to cover some groundwork and some terms. Insulin terminology can be confusing. First, it is very important to remember that this discussion applies to type 1 diabetics only. Type 2 diabetics sometimes use insulin, but that’s a “whole ‘nother ballgame.” There are two types of insulin used for two very different purposes when treating type 1 diabetics. The first is basal insulin, which is used to replace the insulin that the normal pancreas releases constantly—whether we eat or not. Long-acting insulin is used to provide coverage for the basal metabolic needs of type 1 diabetics. Examples are insulin glargine (Lantus) and insulin detemir (Levemir). The most commonly used long-acting insulin is Lantus, so I am going to use that name in this article. (I have no financial ties to the maker of Lantus—I use that name because it is the name most commonly used by patients). The second type of insulin that type 1 diabetics need is short-acting insulin, which is given to cover the carbohydrates in the food they eat. Short-acting insulins are given just before a meal or snack and, ideally, the dose should vary depending on how many carbohydrates are in the food. Examples of short acting insulins are insulin regular, insulin aspart (Novolog) and insulin lispro (Humalog). Again, I will use the term Humalog in this article because it is the term most often Continue reading >>

Sliding Scale Insulin Therapy: How It Works, Doses, Alternatives

Sliding Scale Insulin Therapy: How It Works, Doses, Alternatives

A healthy pancreas releases a burst of insulin as a person begins to eat. This prepares the body for the intake of glucose that is to come. For people who have type 1 diabetes or insulin-deficient type 2 diabetes, these bursts must be recreated through insulin injections either before or after a meal. The sliding scale is one way of working out how much insulin to take before each meal. Most doctors advise against the sliding scale approach. In fact, the American Diabetes Association have pushed for this treatment method to no longer be used. How the sliding scale works The "sliding scale" is actually a chart of insulin dosages. A doctor creates this chart based on how the patient's body responds to insulin, their daily activity, and an agreed-upon carbohydrate intake. As one moves along the chart, insulin dosage changes depending on two factors: Pre-meal blood glucose level This is usually plotted from low to high, down the chart's left-most column. As one slides from top to bottom, insulin dosage increases. This is because more insulin is needed to manage greater amounts of blood glucose. Mealtime This is usually plotted along the chart's top row. As one moves from breakfast to lunch to dinner within the same blood glucose level, dosage may vary. This is because insulin sensitivity, the way the body responds to insulin, can change throughout the day. The fat content of meals can also change through the day, and the doctor may have taken that into consideration. To work out the right dosage using a sliding scale, people should: test their blood glucose level find the matching blood glucose value along the chart's left-hand column slide horizontally along that value's row, until the current meal is reached take a dosage that matches the number where the two values meet Continue reading >>

Preparation

Preparation

Preparation Patient Details Use 50 units soluble insulin (Human Actrapid) made up to 50 ml with NaCl 0.9% solution. Sign each time: Name: Nurse: date: time: DoB: Nurse: date: time: Hosp No: Nurse: date: time: Ward: Nurse: date: time: Consultant: Prescription (see notes for choice of scales) Blood glucose (mmol/l) Scale A (<40Units/day) Scale B (41- 80units/day) Scale C (81-120units/day) Scale D (>120units/day) <6 0 mls / hr 0 mls / hr 0 mls/hr 0 mls/hr 6.1-7.0 0.5 1 2 3 7.1-8.0 1 2 3 5 8.1-9.0 1.5 3 4 7 9.1-10.0 2 4 6 10 >10.1 3 6 6 13 Dr to cross through scale not used and sign: Date and time: Administration soluble insulin (Human Actrapid) 1 unit / ml Date: Date: blood glucose (mmol/l) insulin ml / hr midwife sign blood glucose (mmol/l) insulin ml / hr midwife sign 00.00 00.00 01.00 01.00 02.00 02.00 03.00 03.00 04.00 04.00 05.00 05.00 06.00 06.00 07.00 07.00 08.00 08.00 09.00 09.00 10.00 10.00 11.00 11.00 12.00 12.00 13.00 13.00 14.00 14.00 15.00 15.00 16.00 16.00 17.00 17.00 18.00 18.00 19.00 19.00 20.00 20.00 21.00 21.00 22.00 22.00 23.00 23.00 Total mls: hrs: Total mls: hrs: Guideline for Administration of Supplementary IV Insulin Following Betamethasone in Patients Receiving Insulin for Gestational or Pre-pregnancy Diabetes Mellitus. · Patient will need to be cared for in an environment where the staffing levels allow hourly observation. · Immediately prior to the first Betamethasone injection, a supplementary, variable dose intravenous insulin infusion is commenced (see chart for instructions). The hourly rate is adjusted according to hourly blood glucose measurements. The initial dosage is determined according to her current 24 hour subcutaneous insulin requirements (short + long-acting) (see Supplementary Insulin Requirement Table). · Following admini Continue reading >>

Dosing Insulin

Dosing Insulin

One of the things patients often fear about being diagnosed with diabetes is insulin injections. In most cases, if you have type 1 you will be taking insulin a number of times a day. And, most likely because you are new to diabetes, the decision about which insulin to take and how to take it will be made by your health care provider. But as you learn more about the disease and improve your self-management skills, you will be able to participate more fully in your care. If you have type 2 and are transitioning to insuli—or transitioning from taking one injection of basal insulin a day to a regimen that has you injecting insulin before each meal and a dose either at bed or in the morning—it can be anxiety provoking. It is a stark indication that your pancreas is no longer providing sufficient insulin. Whether you have type 1 or type 2, if you need to take multiple injections of insulin a day, understanding the different ways insulin is titrated can be empowering—and having a discussion with your health care provider about which way may suit your circumstances the best, can diminish apprehension and give you a measure of control. There are three basic regimens available for people who use a basal/bolus approach. Fixed Dose With this method, a set amount of insulin is given at each meal, and the amount per meal can be the same or different. For example, someone may take 6 units at breakfast, 4 at lunch and 8 at dinner, or 8 for all meals. The advantage of this method is primarily ease-of-use. The amount is the same regardless of your blood glucose readings or what you eat. The downside is its rigidity. If your blood sugar is very high before a meal, it is unlikely that the insulin given will be adequate to bring your glucose down to target levels after the meal. The s Continue reading >>

Guide To Starting And Adjusting Insulin For Type 2 Diabetes

Guide To Starting And Adjusting Insulin For Type 2 Diabetes

Adapted from Guide to Starting and Adjusting Insulin for Type 2 Diabetes, ©2008 International Diabetes Center, Minneapolis, MN. All rights reserved. Many people with type 2 diabetes need insulin therapy. A variety of regimens are available. Here are some tips when discussing insulin therapy:1 Discuss insulin early to change negative perceptions (e.g., how diabetes changes over time; insulin therapy as a normal part of treatment progression). To encourage patient buy-in, it may be more strategic initially to begin with a regimen that will be the most acceptable to the patient even if it may not be the clinician's first choice (e.g., pre-mixed instead of basal-bolus regimen).2 Provide information on benefits (e.g., more “natural” versus pills, dosing flexibility). Consider suggesting a “trial” (e.g., for one month). Compare the relative ease of using newer insulin devices (e.g., pen, smaller needle) versus syringe or vial. Ensure patient is comfortable with loading and working a pen (or syringe). Link patient to community support (e.g., Certified Diabetes Educator [CDE] for education on injections and monitoring; nutrition and physical activity counselling). Show support — ask about and address concerns.2 Consider initiating insulin if…3 Oral agents alone are not enough to achieve glycemic control or Presence of symptomatic hyperglycemia with metabolic decompensation or A1C at diagnosis is ≥ 9%. Timely adjustments to and/or additions of antihyperglycemic agents should be made to attain target A1C within 6 to 12 months.3 Standard target blood glucose (BG) goals for type 2 diabetes:3 Before meals 4 to 7 mmol/L Two (2) hours after meals 5 to 10 mmol/L (5 to 8 mmol/L, if A1C targets are not being met) A1C ≤ 7% (Less stringent A1C goals are appropriate for som Continue reading >>

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