Insulin is a hormone produced by the pancreas that works to transfer glucose from the bloodstream into the cells of the body, to be used for energy. For some diabetics, synthetic insulin is required to regulate their blood sugar levels.
An insulin sliding scale is a method some insulin users follow, to manage blood sugar, by adjusting their insulin dose based on their blood sugar value.
Usually their doctor provides them a chart that has glucose ranges listed and a corresponding insulin dose that allows for real time adjustments to be made to address elevated glucose levels.
Lets explore the insulin sliding scale chart with a detailed step-by-step guide on how to effectively understand and use it.
What Is an Insulin Sliding Scale?
The insulin sliding scale approach to dosing insulin is often used when people start on insulin, when they are hospitalized, or when they are being discharged from the hospital.
It’s usually considered a simpler way to dose insulin, but it definitely has limitations in its ability to accurately dose and correct a high or cover meals with varying carbohydrate counts.
The chart is usually created by a doctor who uses a calculation using a persons’ weight. Additionally they take into consideration several other factors such as: what type of diabetes they have, their sensitivity to insulin, previous patterns of glucose trends, age, and activity levels.
A target glucose is set and glucose ranges are divided into intervals, for example: 150–200
mg/dL, 201–250 mg/dL, etc. Then, for each glucose range, a corresponding insulin dose is assigned. Typically rapid-acting or short-acting insulins are used for sliding scales.
When glucose is checked, the glucose reading is matched to the specific corresponding insulin dose in the chart.
The insulin sliding scale chart is commonly used for pre or post-meal corrections, temporary insulin adjustments when sick and glucose is elevated, or when in hospital settings.
How to Read an Insulin Sliding Scale Chart
When a sliding scale chart is provided to a person, usually the provider who created the chart has a few different tables/templates that they can choose from, but they all have similar layouts.
Usually on one side is a column of the blood sugar ranges and then on the other side is the insulin dose column to match up with the blood sugar range. See following table for example:
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Using the above insulin sliding scale chart, a person would check their glucose level using whatever glucometer or cgm they use, find the glucose level within the range column and then take the amount of insulin in the corresponding insulin column. The provider would specify which insulin they are to take.
Let's do a couple examples!
Example 1: In this example, the provider directed the user to take insulin 3 times per day, prior to each meal based on the sliding scale example above. Just prior to breakfast, they check their blood sugar level and it is 187 md/dL. They find where the glucose level falls on the left glucose level column, which happens to be the first step with 187 falling between 150-200. They look at the corresponding insulin column and determine they are to take 2 units of insulin prior to their meal. |
Example 2: In this example, the insulin user has “sick day rules” that increase their insulin dose by a certain amount based on their glucose, and that is what the above chart represents. This person is fighting an upper respiratory infection and their glucose has been elevated much more than normal. This person has fixed doses of 10 units of rapid acting insulin prior to meals, but has been advised to add the above amount of insulin to each fixed dose per the sliding scale. It would look like this - before lunch, they check their glucose levels and it is 265 mg/dL. For this example, they would take the fixed 10 units and then look at the chart and find the range this number fits in, which would be 251 - 300 and take the corresponding additional insulin dose of 6 units, for a total of 16 units. |
Step-by-Step Guide to Using an Insulin Sliding Scale
Step 1: Check your blood glucose level using whichever glucometer or CGM you use
Step 2: Find the corresponding blood sugar range on the chart.
Step 3: Look at the corresponding insulin dose column recommended for that range.
(Note: If the sliding scale is in addition to a fixed insulin dose, add the two to determine
the correct dose.)
Step 4: Administer the insulin dose safely and accurately.
Tip: If glucose is higher than what the scale goes to, usually the provider advises to take the highest dose and reach out to their doctor, as well as possibly check for ketones.
When to Use and When to Adjust the Sliding Scale
There are some scenarios where the insulin sliding scale chart is more appropriate than other insulin delivery methods. One such scenario is when a person is hospitalized and needs to get started on a conservative amount of insulin that is easily trackable and simple to manage.
One thing to remember about insulin sliding scales is that they may need frequent adjustments and therefore the insulin user should be advised of the importance of regular reviews and data analysis by their healthcare provider.
If for example, a person using a sliding scale consistently had hypoglycemic episodes following their meals, the provider will likely adjust their sliding scale so that they are getting less insulin.
Conversely, if they are consistently elevated following meals, despite taking their insulin as instructed, this may indicate a need to strengthen their sliding scale.
It is very important that insulin users, on sliding scales, visit their health care provider often to discuss and analyze their glucose data and make adjustments as needed.
Limitations of the Sliding Scale and Alternatives
Although sliding scales can be fairly simple for many people, they definitely have limitations. For people who desire to have really tight control over their glucose levels, usually using an insulin to carb ratio, target, and correction factor will help better attain this goal.
Often when people use an insulin sliding scale chart, it is strictly used for meals and not for corrections in between, which often leads to a more reactive approach than a proactive one.
If a person is using carb counting and calculating their target, carb ratio, and correction factor, and doing this potentially every 3 hours (to try to avoid insulin stacking), this is a much more proactive approach and will usually result in overall more stable glucose levels than an insulin sliding scale chart.
Tips for Beginners Using an Insulin Sliding Scale
If you have just been given an insulin sliding scale, it would be beneficial to keep an insulin log, or periodically review your glucometer/cgm download to look for patterns. This will help you and or your healthcare team to be able to make informed decisions regarding current scale and if adjustments need to be made.
It is also very important to be consistent with monitoring glucose and your dosing timing. This is helpful again in making informed decisions based on what your current regimen is.
For example, if you take your insulin before breakfast and lunch, but always take it after your dinner, this either needs to be consistent, or at the very least, documented so that the provider has all the knowledge of how it is being used to make effective adjustments.
If you have any questions or feel that you may not fully understand how to use the insulin sliding scale, then do not hesitate to consult with a diabetes educator or health care provider.
Having a good understanding of how to use an insulin sliding scale chart is very important and will facilitate more effective treatment. If you have questions, don’t hesitate to ask and even request to practice with your healthcare provider.
If you would like to learn more about your sliding scale and how you can get the most out of it and bring your glucose and A1C to target, reach out to me. Book your free call here!
As a Diabetes Care and Education Specialist (CDCES), I can help you make personalized adjustments to finally achieve your goals and live your best life!
Meet the Author
Hi! I’m Beth, a Registered Nurse and Certified Diabetes Educator. I provide diabetes coaching for newly diagnosed people with diabetes and also work with people who have been living with diabetes for some time.
With 1:1 coaching, you will feel Empowered and supported to confidently manage your diabetes effectively - without it controlling your life! I can help you make sure that you feel good, stay in optimal health and take care of your well-being at all times.
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