Can you please demonstrate some examples of "how to put everyone on sliding scale in addition to basal bolus regimen." I am a little bit confusing about the following scenario: a 60 kg patient with estimated TDD : 0.4*60=24 units of insulin and divided it to 12 units of glargine qHS + 4 units of aspart TID AC. if the paitent had a pre-lunch glucose 240. Are you saying that i adjust my bolus insulin by increasing 20% ? (which is 4 units *120% = 4.8 units or ~ 5 units) or we just gave the insulin dose based on the sliding sclae table and add on to the original 4 units? Thanks for your educational videos!! They are very informative.
Great question! I think in your scenario it depends on what their fasting AM glucose was. If the fasting AM glucose was also elevated in the 200s, then I would probably just take their whole TDD of insulin (24 units in this case) and increase it by 20% which would get you to about 30 units, then divide it again so you would get 15 units glargine qHS and 5 units aspart TID AC. If their fasting AM sugar was normal or low though, say, 100, then yes I would just increase the aspart dose by 20% like you mentioned in your post (and leave the glargine untouched)! It is all a bit of an art - but the 20% and 30% increases are basically a rough estimation of what a reasonable next dose to try would be!
Just my second day as an intern at the MICU. This is extremely helpful.
this is great, thanks
How do you not have more views and likes!
Wow thank you! This series is great!
So helpful and clearly explained - thanks so much!
Can you do a video on how to start an outpatient insulin regimen?
Godsend, finally I warped my head around insulin management
Thanks for the quick summary!
Can you please demonstrate some examples of "how to put everyone on sliding scale in addition to basal bolus regimen."
I am a little bit confusing about the following scenario:
a 60 kg patient with estimated TDD : 0.4*60=24 units of insulin and divided it to 12 units of glargine qHS + 4 units of aspart TID AC.
if the paitent had a pre-lunch glucose 240. Are you saying that i adjust my bolus insulin by increasing 20% ? (which is 4 units *120% = 4.8 units or ~ 5 units) or we just gave the insulin dose based on the sliding sclae table and add on to the original 4 units?
Thanks for your educational videos!! They are very informative.
Great question! I think in your scenario it depends on what their fasting AM glucose was. If the fasting AM glucose was also elevated in the 200s, then I would probably just take their whole TDD of insulin (24 units in this case) and increase it by 20% which would get you to about 30 units, then divide it again so you would get 15 units glargine qHS and 5 units aspart TID AC. If their fasting AM sugar was normal or low though, say, 100, then yes I would just increase the aspart dose by 20% like you mentioned in your post (and leave the glargine untouched)!
It is all a bit of an art - but the 20% and 30% increases are basically a rough estimation of what a reasonable next dose to try would be!
Is sliding scale the extra insulin on top of the basal dose?
yep
life saver