What does "sliding scale" mean?

Hi everyone -
I have an appt tomorrow morning to meet with an educator and officially go off oral meds and onto insulin. I could stay on oral meds for a while but I’m considering trying for baby #2 and my current numbers are not acceptable for pregnancy. They’re not really sure if I’m type 1 or 2 but my endo is leaning toward early Type 1.5. Anyway, I went off metformin and Januvia end of last week and within a day started to see my numbers go up. I heard it takes a couple of weeks for it to fully get out of your system but i pretty quickly start seeing post prandial numbers around 180. Anyway…to my reason for the post! Any advice for questions to ask tomorrow? I already have a list! Also, what the heck does a “sliding scale” mean? I can’t seem to find a straight forward answer. Is it different than administering bolus insulin based on carb counting or the same thing?


Sliding scale is when you dose yourself with insulin based on the number of carbohydrates you intend on eating. Your doctor will help you determine your insulin to carb ratio and you will apply it to what you are going to eat. You will learn how to count carbs and you’ll find many databases online that list foods, and prepared meals carb values. It’s all a bit confusing in the beginning, but you’ll get it in time. Good luck!

Per a Johns Hopkins book I have published in 1997, a sliding scale is when you decide your bolus dosage on a scale that is determined by your doctor based on your blood sugar before the meal. For instance if your blood sugar is 80-100, take x number of units, 100-120 take y number of units, etc. I have a friend who does this and then he adjusts the dosage up a bit if he is eating a more carb heavy meal. But even that 12 year old book goes on to say that a formula based on the carbs you are going to eat as well as where your blood sugar stands is more exact. It also discusses carb counting. I haven’t told my friend how outdated his method is!

You do not want a sliding scale - it’s better than fixed meal dosages, but only barely - it is a very antiquated regimen (a slight improvement from the days when people had fixed dosages of R and N and little ability to self-manage their control). You really do want to carb count, you want to know your insulin to carb ratio, and you want to know your insulin sensitivity factor - those two things and an ability to “see” what is in a meal are all you need to figure out your mealtime/bolus insulin.

Sliding scale means your doctor was educated in the 1980s and hasn’t updated his knowledge since then.

Seriously. It’s a terrible way of dosing fast acting insulin that doesn’t take into account how many grams of carbs you eat at a meal.

If you saw a dramatic change in your blood sugar after dropping metformin and Januvia, you might be Type 2. Probably not autoimmune Type 1.5. Possibly MODY but that is fairly rare.

Thanks everyone! That explains the sliding scale thing much better. And just to clarify, my doctor is NOT putting me on a sliding scale. I’ve just been doing a lot of research about starting insulin and that terms keeps coming up and I wanted to know what it meant. From my brief phone conversation with my doc last week I * think * he’s planning to put me on some type of basal insulin and Humalog for pre-meal insulin (dosage based on anticipated carb intake at that meal). I’ll learn more tomorrow I guess.

On the Type 1.5 or 2…it could be anything I’ve come to figure out. And now that i’m going on insulin I’m less concerned about the type since insulin is the eventual and best treatment for any type (so I hear). Even though I was GAD and islet cell antibody negative, I’m thin with no family history of diabetes but do have a family history of autoimmune disorders (including one myself). Plus, I’ve heard many people say that oral meds can often work for a while in a Type 1.5, not always but sometimes for a couple of years. I was just diagnosed in February so I’m really new to all of this. Metformin on worked by itself for a couple of weeks and then we had to add the Januvia. I’m sooo nervous about going on insulin for Metformin really upsets my stomach so I’m not heartbroken over stopping that stuff!

Thanks everyone for the information! : )

Dear Esmom.

It is a shame that we have to wait for insulin until our own pancreases are toast. With some basal like lantus or levemir and humalog you should do well. Weight gain is a problem if you have any insulin resitance. May need a lot of exercise to counteract but you will see soon enough.