Sliding Scale Insulin Therapy; How It Works

Insuling Sliding Scale Cover Photo
Insulin Sliding Scale Therapy

Sliding scale insulin therapy, a frequently administered insulin regimen amongst diabetic individuals, has been in use for many decades as one of the standard care procedures for avoiding complications. 

If you have recently been diagnosed with diabetes, your healthcare provider may decide your course of treatment. However, it would be helpful for you to gain an insight into the management options so that you can make informed decisions and manage your treatment with your healthcare provider’s supervision.

This article highlights the process of sliding scale insulin therapy and the various aspects associated with the treatment procedure. It also weighs the procedure against other insulin therapy regimens.

Insulin Administration

Diabetes is one of the most prevalent chronic diseases in the world. A potentially life-threatening enduring condition, renders the body to not produce insulin or have insufficient insulin production, resulting in significantly higher glucose levels, which also can be called hyperglycemia.

Whether or not they have diabetes, hyperglycemia in individuals is associated with a greater risk of complications, increased hospitalizations, admission to intensive care units, prolonged hospital stays, and unfortunately, even mortality.

If your pancreas is not working and the body’s blood glucose level stays above the normal range for a prolonged time, it can have a significantly detrimental impact on health. For instance, it can inflict damage to the kidneys and eyes and can also be a cause of stroke or heart disease.

The premise of diabetes management is based on the use of insulin based on their course of treatment. Individuals having type 1 diabetes or type 2 diabetes, in some cases, need to get multiple injections of supplemental insulin in a day to regularize their blood glucose levels and keep them within the normal range. Some diabetics have to take additional medication (such as Byetta and THZ‘s) along with their insulin to manage their blood glucose more effectively.

In this regard, individuals can take insulin based on the treatment method they are following. The common methods include fixed-dose insulin therapy, sliding-scale insulin therapy and carbohydrate to insulin ratio.

Here is how the sliding scale insulin therapy works.

Sliding Scale Insulin Therapy

The sliding scale insulin therapy takes into account the blood sugar level just before you consume a meal. The insulin dose administration is directly proportional to the blood sugar level, i.e., the higher the level, the higher the amount of insulin you need to inject.

How Does the Sliding Scale Work?

For most sliding-scale therapy regimens, the individual’s blood sugar level is checked through a glucometer around four times a day, with a gap of five to six hours. Individuals usually need to check their levels before meals or their bedtime. Since insulin is administered before mealtime, usually fast-acting insulin is administered for the sliding scale therapy to work effectively.

Here is how the regimen usually works.

You need to check blood glucose levels through the glucometer at least 15 minutes before taking a meal. You also need to check the levels 15 minutes before your bedtime.

In case the blood glucose level is above 150mg/dL, you may need to take certain insulin units prescribed by your doctor. Generally, it implies that you may have to take 1 to 3 insulin units for every 50 mg/dL above 150 mg/dL, as shown in your glucometer.

In case your blood sugar level before the meal is within the normal range, it doesn’t mean you can do without administering insulin. Even if the value is less than 140 mg/dL, you may still have to take fast-acting insulin. It all really depends on what your healthcare provider has suggested, as each diabetic’s case is different.

Timing for insulin sliding scale
When using the insulin sliding scale therapy, timing plays an essential role in monitoring blood glucose levels.

The 15-minute window for checking the blood sugar value is advised, as this is how much it takes for the fast-acting insulin to take effect. It starts working within 15 minutes of administration and stays effective for around two to four hours.

The dose can be a fixed number of units you have to take with each meal or a variable amount that depends on the amount of carbohydrates you consume in the deal; for instance, you may need to take 1 unit for every 20 grams of carbohydrates consumed.

The Challenges of Sliding Scale Insulin Therapy

The sliding scale insulin therapy is a more precise method than other regimens, as it considers the exact blood sugar levels before insulin is given. However, it is based on the assumption that the individual will consume a fixed carbohydrate portion in the particular meal. Here are a few concerns with this management protocol.

It may not be effective in managing blood sugar

Sliding scale insulin therapy is basically a reactive strategy designed to respond to elevated blood sugar levels. Although hospital and nursing staff use it commonly over the years, scientific evidence suggests it may not be very effective in regulating or lowering blood sugar levels in patients.

May lead to prolonged health issues

Since it is based on the assumption of a fixed amount of carbohydrate consumption during the meal, it may at times result in very low blood sugar levels. It is also why individuals using this method may find themselves staying at hospitals longer than individuals using other methods such as the fixed-dose insulin therapy, which we will discuss later.

Does not consider personal factors

Another noteworthy aspect is that sliding-scale therapy does not account for personal factors such as the amount of carbohydrates in the diet. Individuals may take the higher or lower amount in a particular meal based on their preference. Also, there may be “hidden carbs” in certain foods that the patient does not know about it.

Similarly, it also does not account for the individual’s weight as two individuals having different weights may be getting the same amount of insulin. Moreover, the sliding scale method also does not consider the amount of insulin the individual may have been getting in the past or how the person responds to insulin resistance.

It may not be convenient

As mentioned in the regimen process, individuals using sliding scale therapy need to check their blood sugar multiple times a day. It can be quite a hassle and also troublesome if you don’t like pricking your fingers.

Requires a strict diet

Unless you modify the insulin units according to the carbs consumed in a particular meal, you may be bound to keep your carbs within a certain range in every meal. You also need to be consistent with your meal timings and have to take your meals around the same time every day (which can be a major pain).

Alternative Insulin Therapies

As suggested earlier, in addition to the sliding scale insulin therapy, two other prevalent regimens are fixed-dose and carbohydrate to insulin ratio. Let’s look at them one by one.

Fixed Dose insulin therapy

Fixed-Dose Insulin

As per the fixed-dose insulin therapy, individuals have to take a certain pre-determined amount of insulin units with every meal.

For instance, an individual may take five units at breakfast and six units at dinner. Since the insulin dosage is pre-determined, it does not take meals or macro-nutrients into account.  

The fixed-dose insulin therapy is a convenient method to administer insulin, particularly for individuals who have just started using insulin. However, the consideration is that this method does not take into account the blood sugar level before meals. Moreover, it also does not account for the varying portion of carbohydrates consumed in a particular meal.

Carbohydrate to Insulin Ratio Therapy

In the carbohydrate to insulin ratio method, individuals need to take a certain amount of insulin according to a certain portion of carbohydrates they will consume. For instance, if for a certain meal of the day, your carbohydrate to insulin ratio is 10:1 and you consume 20 grams of carbs in that meal, you will need to take 2 units of insulin before eating to cover that meal. This is just a general example and should not be used in practice without the advice from your healthcare professional.

Another consideration for this therapy is the correction factor. This element is intended to take into account the blood sugar level before a meal. To understand it better, let’s consider the following method.

Let’s assume you want your blood sugar level to be under 140 mg/dL before a meal, but it is 160 mg/dL. If you have been directed to use one unit of insulin for every 50 mg/dL, then your value is above the normal range and you will need to take an additional unit of insulin before the meal to bring the sugar level within your desired range.

The carb to insulin ratio is a little tricky to master and requires considerable knowledge and practice. However, if you can manage this method, you can effectively control your blood sugar level after the meal.

Conclusive Remarks

The importance of insulin for managing blood sugar levels cannot be denied. However, administering it may be overwhelming, particularly for beginners. We hope this article was able to provide insight into the relevant aspects and different therapies used to assist with administering insulin.

While sliding scale insulin therapy has been in use for many years, more research is being done in the area proving that there are better performing alternative therapies out there.

In recent years basal-bolus insulin injections have emerged as the preferred means of managing blood sugar levels as they have proven to be more effective in regulating an individual’s blood sugar levels throughout the day.

It is important to consider that diabetes does not have a standard management procedure that may suit every individual. At the end of the day, you need to consult your healthcare advisor, who will draft a plan with you that addresses your respective needs and suits your lifestyle. Please do not incorporate any of these therapies without the consent of your healthcare professional.