sliding scale

[Asterix]

can someone explain this concept? how does it work etc. I have read a few articles on the net without much info.

[Nik]

Sliding scale insulin is usually used in diabetics who are likely to be NBM for a particular period of time, so it will often be initiated in surgical patients. Essentially it's a continuous IV infusion of insulin, adjusted based on blood glucose measurements according to a sliding scale. Fluids including glucose are infused in a separate line. Rate of insulin administration is generally fixed for a given range of blood glucose levels. Different hospitals will have different procedures - if blood glucose falls below a certain level, the rate of insulin will drop. If blood glucose rises, insulin rate will rise, etc.

[Asterix]

insulin is usually stopped in surgical patients but what is the reason for this. why would you infuse glucose for such patients?

[crit care]

usually because they are going for theatre and so won't be eating...so if you aren't eating why would you want to give insulin.....

[Nik]

[QUOTE=Asterix;60055]insulin is usually stopped in surgical patients but what is the reason for this.[QUOTE]

Usual s/c insulin will be switched to IV which has a more predictable absorption profile and allows for easier dose adjustment. Type 1 diabetics should never be without insulin.

why would you infuse glucose for such patients?

Let me get this straight - you're asking why someone on insulin should be given glucose ?!

[Asterix]

what I am saying is you try to reduce glucose in patients with diabetes so why infuse them on glucose

[Nik]

what I am saying is you try to reduce glucose in patients with diabetes

Yeah but does that mean that their bodies should be totally without glucose ? The aim is not to reduce it to miniscule levels, but to manage it within appropriate and safe blood levels. If we just kept them on insulin they would go hypo. What would we treat it with ?!

[Asterix]

yes but wouldn't it be hard to find the balance between the glucose given and the amount of insulin given. Am I right in thinking any insulin such as novorapid etc are stopped when the sliding scale is used

[crit care]

you measure blood sugars on a regular basis so can adjust the amount of glucose and insulin whihc is given

yes, when on sliding scale all regular insulin and anti-diabetic meds are stopped

[Asterix]

Can you ever be on both tablets and a sliding scale.