Starting Feb. 4, the nighttime sliding scale/correction bolus dose will change. To reduce the incidence of nocturnal hypoglycemia, the scale will start at a higher CBG (180 mg/dL rather than 141) and each dose of insulin will be reduced by one unit.
Current state:
|
Blood glucose (mg/dL) |
Insulin sensitive (Mild) |
Standard (Moderate) |
Insulin resistant (Severe) |
|
141-180 |
1 unit |
2 units |
3 units |
|
180 - 220 |
2 units |
3 units |
4 units |
|
221 - 260 |
3 units |
4 units |
5 units |
|
261 - 300 |
4 units |
5 units |
6 units |
|
301 - 350 |
5 units |
6 units |
7 units |
|
351 - 400 |
6 units |
7 units |
8 units |
|
Over 400 |
7 units |
8 units |
9 units |
Future state:
|
Blood glucose (mg/dL) |
Insulin sensitive (Mild) |
Standard (Moderate) |
Insulin resistant (Severe) |
|
180 - 220 |
1 unit |
2 units |
3 units |
|
221 - 260 |
2 units |
3 units |
4 units |
|
261 - 300 |
3 units |
4 units |
5 units |
|
301 - 350 |
4 units |
5 units |
6 units |
|
351 - 400 |
5 units |
6 units |
7 units |
|
Over 400 |
6 units |
7 units |
8 units |
This change was proposed by the Diabetes Steering Committee and approved by the P&T Committee. The absolute rate of hypoglycemia was 20% higher when a patient received a dose from the dinner time scale, the HS scale and a dose of long-acting insulin. By reducing the aggressiveness of the HS scale, the rate of hypoglycemia in patients receiving all three doses should decrease.
If you have questions, please feel contact: