Insulin sliding scale

Question 1

When should an insulin sliding scale be used?

Answer 1

Diabetic patients who are a) undergoing surgery and/or b) acutely unwell and unable to tolerate oral intake

Question 2

How often should capillary glucose be tested during IV insulin infusion?

Answer 2

Hourly

Question 3

What should happen to the patient’s daily long-acting subcut insulin (e.g. Lantus, Levemir)?

Answer 3

This should be continued but these patients may need less IV insulin

Question 4

What should be used for the insulin infusion?

Answer 4

A short-acting insulin e.g. Actrapid via a syringe driver

Question 5

In what situations might a patient require a more “intensive” IV insulin scale?

Answer 5

Obese (insulin resistant), on steroids

Question 6

Action plan is blood glucose falls below 4?

Answer 6

Infuse 50mls 10% glucose IV, switch scale

Question 7

Standard fluid prescription with a sliding scale?

Answer 7

500ml 10% glucose with 10mmol KCl, infused at 100ml/hour via an infusion pump

Question 8

When should potassium be omitted from the IV fluids?

Answer 8

If K+ > 5mmol/L, or CKD 4/5

Question 9

Management of DKA? (4)

Answer 9

Fluids (NaCL +/- potassium depending on levels)
IV insulin 6 units/hour, subsequently adjusted to maintain BG 9-14
Commence IV glucose 10% when BG falls below 14
Try to identify precipitant e.g. infection

Question 10

How should the transfer from IV to subcut insulin be made?

Answer 10

IV should be continued until established on subcut and tolerating oral fluid and diet