Sliding scale

Does anyone still use the sliding scale? If so, what criteria do you use for it? I'm having a fight with a doctor my mom saw while she was in the hospital who disagrees with me about the sliding scale we've been using. I swear, doctors are such arrogant pricks sometimes that I want to kick them back where they came from...

Well, sliding scale is kind of old school, Cara. It's much more successful to use an Insulin to carb ratio so that you bolus for the exact amount of carbs you are eating. Then you can add in a correction if needed (if you are high) based on your ISF or correction factor. Have you read Using Insulin by John Walsh. It's a good book to learn the more up to date dosing. If your doctor is suggesting an I:C ratio, then he is up to date unlike many!

Your post sent me looking for a good description of what "sliding scale insulin therapy" actually is. My general understanding is that it's old-fashioned and reactive rather than proactive or anticipating insulin doses based on carb consumption, activity, and stress.

Hospitals have a long history using sliding scale and I've read many disastrous blood sugar results from experienced PWD in a hospital that uses sliding scale.

The University of California at San Francisco has a good web page that describes sliding scale insulin well. The biggest thing that I learned from visiting this site is that the sliding scale insulin system depends on eating consistent levels of carbohydrates at the same time every day. Live by the clock or suffer the consequences! It reminds me of using NPH insulin and the absolute requirement of eating lunch at an exact time or else suffering a debilitating hypo.

I much prefer the flexibility of the more modern basal/bolus dosing method. This allows me to adjust when I eat and respond appropriately with high BG corrections in a timely manner.

I know that if I ever end up in the hospital and still have good physical and cognitive abilities, I will totally and vigorously resist any attempt remove me from the diabetes treatment driver's seat and use sliding scale insulin. But that's another topic.

Good luck with your mom. I suggest that the best argument to use with your mom's doctor is to show him the out-of-control BGs that your mom suffers when using his system. There is plenty of strong medical evidence that demonstrates the poor BGs lead to poor and slow healing. What about his oath to "first, do no harm"?

You've gotten good info from other posters. I haven't used sliding scale in a very long time (actually, in the last century I think). The sad truth is that there are still a lot of docs that have their patients use the sliding scale, when those patients could get better control and have more flexibility by using testing, observation, and grade school math.

On the other hand, I agree with you entirely that a lot of docs are incredibly arrogant. Unfortuantely, this one seems to know what he's talking about.

Thanks for the replies. I guess I should have been more specific about a couple things. I do agree that the sliding scale is an outdated method, but that's what she's been using and that's what certain doctors mom's seen insist that she use. Since my mom used to be on a pump until her insurance didn't pay for supplies anymore, we use both the sliding scale and carb counting when correcting her blood sugar levels. We still use her pump sometimes for difficult calls, or times when I don't want to have to guess when using that old sliding scale. When I tell doctors about this they don't seem to understand the part about using the sliding scale to correct for the actual blood sugar and then using carb counting to correct for meals/snacks when necessary. It makes perfect sense to me, but to the educated doctors it's like I'm speaking Klingon.

The term sliding scale is generally used to describe the calculation of a meal-time bolus based on correcting your before meal blood sugar. The term correction bolus is used to describe an injection to bring your blood sugar into target range when you have not eaten for some hours. It is based on an Insulin Sensitivity Factor (ISF) which takes into account your blood sugar and computes a bolus.

The difference is that traditionally a sliding scale would be a lookup table provided to a patient and it would apply to the meal while the correction bolus applies to correcting a blood sugar. Even through the calculation is essentially the same, the factor is different.

You should not be using a sliding scale to compute correction bolus. You need to ask the doctors to help you establish an appropriate ISF for correction boluses. I think you have ended up talking at cross purposes with your doctor, hopefully by referring to correction boluses and an insulin sensitivity factor you can get their help.

I used to get cortisone injections in my knees for pain. After a 500 reading without any insulin, my docs and I agreed a sliding scale would be the answer.....and it was. I am okay from 0 to 150....151-200 I use 2 units; 200-250 three units; 250 - 300 is four units and anything over 300 I am to call the ER or doc for further instructions. This worked with humalog. Now I am on humalog with the same scale, before meals, and lantus nightly at 15 units. This has only been for a week....but so far so good. Good luck. Stick to your guns, sometimes we do know more than the docs know.