Stupid question on sliding scale

Have question on where I should base my target range for mdi bg correction. I am on an intensive management approach until I get on pump and try to keep my bg at 100-120 fasting and before meals. Should i be targeting lower or upper in that range. For example i was 174 when i got up used lower range (100) for target so was a 74 point correction. Tool 4 units humalog (actually for 80-100) hour later i am at 80. And must add first reading was actually 171 hour later was 174 so thats when i corrected.

Not stupid at all. Getting a soft landing from a correction is one of the hardest things to do—I find it almost impossible not to over- or under-shoot. The times I get the curve to flatten out right where I want it (I use a CGM) always feel like minor triumphs to me, though nobody else understands what my “YES!!!” is about, even when I explain it to 'em. My wife be like “That’s nice hon,” but I can tell she’s underwhelmed. Sigh.

Anyway, probably safest to try correcting to the top of the range and see how it goes after an hour or so. 80’s not terrible, but if you end up going hypo and having to treat for that you can end up riding the D-coaster.

Thanks for answering, I’ve been fighting here lately, was on pump for awhile (couple years 530g) then went off. Endo moved away used pcp for the last year. He would only put me on 70/30 s*** which dose not work for me. So in December I found new endo who like me wants me back on pump (am trying) but for now I am mdi. Was actually using scale as readings as 200 bg reading would correct for 200 verses 100. After riding rollercoaster all month finally sat down and went over what I Was doing (yesterday) and realized what I was doing. Been t1 20+ years and still mess up.

Oh god, not that. Totally old-school, but comfortable for PCPs because they don’t have to train you in all that carb-counting and figuring out all your ratios and all that stuff they don’t know themselves, not being specialists. Easy-peasy for them, not so great for us. I was on it for 20 years because I couldn’t get a referral to an actual endo. S*** is right.

If you are down to 80 after 1 hour, you took too much. (Unless that was correction plus meal bolus).
Humalog lasts 3-5 hours, so your BG will continue to drop if it was without meal.

The term sliding scale was used in the old days, when Regular was used for meals. If your pre meal BG was high, sliding scale meant how many units to add based on pre-meal BG.

Typically when correcting for a high BG, minimed pump uses the sensitivity setting, others call it correction factor.

Keep in mind these are approximations. You BG will NOT consistently drop X amount for Y units.

From Healthline, "In the sliding-scale method, the dose is based on your blood sugar level just before your meal. The higher your blood sugar, the more insulin you take. SSI therapy has been around since the 1930s. It’s most often used in hospitals and other healthcare facilities because it’s easy and convenient for the medical staff to administer.

SSI has become controversial in recent years because it doesn’t control blood sugar very well."



Have been using sliding scale as correction factor. Have been staying at around 80. Just now ate at 27g carb. Breakfast biscuit. Trying to see what my correction dose did to me and how long it acted with no food. Now I want to see what the food does. Have been trying to get into pump to see what #'s it was set at but let me get past fill tubing. Even put empty reservoir in. Mabey I will try to fill with water. My insulin for it is not here yet and only have 60 units left in pen.

This was based on the “fact” that you were given a specific number of “exchanges” per meal, assumed to require the same amount of insulin. So the only variation was the amount to add/subtract (slide) due to BG. Carb counting was not yet in our vocabulary.

That’s what I thought. But many folks wouldn’t recognize that term from the old days.

I recognize it just fine. Exchanges were so weird for me, that I didn’t use them. Once I got turned on to carb counting–now that’s a whole 'nutter ballgame!

Here is more of the article," Many organizations, including the American Medical Directors Association and American Geriatrics Society, don’t recommend that hospitals, nursing homes, and other healthcare facilities use sliding-scale insulin therapy. Instead, they recommend using basal insulin, with mealtime insulin added as needed. Basal insulin involves long-acting insulin injections that help keep insulin levels steady throughout the day. Added to this are rapid-acting mealtime insulin and correction doses to regulate blood sugar levels after meals. Hospitals and other healthcare facilities seem to be listening to these recommendations. Today, they’re using SSI therapy less often than before.

Some experts say that sliding-scale insulin therapy should be phased out completely. But one report from the American Diabetes Association says more research still needs to be done. The report calls for more studies to compare sliding-scale insulin with other insulin regimens before doctors make the final verdict.

You’ll probably only encounter sliding-scale insulin therapy if you’re admitted to the hospital or another healthcare facility. Ask your doctor about how your insulin delivery will be scheduled while you’re there, and what options are available to you.

You can do that with no harm–that’s what they had us do when I was being trained on my first pump.

ah, first injection was into an orange. Remember that?

noooo. u should have been using sterile saline.

The exchanges were a myth. At least for me. I think they were more for the dr’s comfort in pretending there was some rational method they could give us, whereas in reality most of us were just winging it based on past experience, gut intuition, and the SWAG method. But @Dave44’s quotation about the use of it with R/N in the hospital situation underscores its attraction from the medico perspective. It doesn’t require a lot of knowledge or training.

I did, but that was pump training so I was actually infusing the stuff. This person just needs to get the pump to let him check his settings, he’s not actually going to be pumping with it.

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ah, that’s good. :slight_smile:

When I got my first pump they suggested I use saline for the first couple of days. No way. I was way too eager to use it for real.

Yea I do a basal of 35units each night of tresiba and humalog for meal time/corrections, some days I use more humalog than tresiba. My sugar if untreated will go in upper 500’s in no time. When first diagnosed with diabetes I had a bg of 671 was given script for metformin and told not to worry about testing bg’ s that it was overrated, soon as I left bought meter was back almost weekly complaining about #'s, wasn’t long before I was on insulin.

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that is a terrible story, but sadly it’s too common. Even my wife wasn’t diagnosed for YEARS because her bg’s would come down hours after eating carbs. SHe had 3 GTT’s and each time she went into the 200’s. Her eye doc told her she had retinopathy prior to her diagnosis but the docs who are supposed to catch diabetes were asleep at the wheel. Freaking doctors! Some are great, but there are too many that poo-poo symptoms and test results.

Even myself–I had a fasting bg test that was over 130 and the doc said I wasn’t diabetic. It took another 12 months before I was dx’d correctly.