Insulin Sliding Scale Guideline Malaysia

The insulin currently used in malaysia is recombinant human insulin either directly derived from the native human insulin i e.

Insulin sliding scale guideline malaysia. Step down to the next scale when the vriii is restarted i e. Prior to commencing vriii. Per hospital guideline and restart iv insulin within 20 minutes 1 2 life of iv insulin is 7 8 minutes. Variable rate intravenous insulin infusion vriii formerly known as sliding scale insulin has been used for decades to achieve normoglycaemia in hospitals.

Short acting insulin. Insulin medication errors hyperglycemia practice guidelines sliding scale insulin ssi is commonly used to manage hospitalized patients with and without diabetes mellitus 1 2 3 monotherapy with ssi often leads to erratic fluctuations of glucose control because it tries to retrospectively treat hyperglycemia rather than prospectively prevent it 1 4 5 6 7 8 9 10 in the. However when used incorrectly it can result in morbidity from hypoglycaemia excess. These earlier studies used urine glucose for sliding scale but with demonstration of inaccuracy of urine glucose 3 blood glucose replaced urine glucose for sliding scale in diabetic.

Hyperglycaemia guideline insulin sliding scale insulin variable rate intravenous insulin infusion introduction. 6 7 when adding prandial insulin. Regular human insulin or structurally modifi ed i e. In the acutely unwell patient the default solution is usually an intravenous insulin.

It is a very useful tool when used in the right context and has been shown to improve outcomes. Sliding scale regular insulin ssi in the management of patients with diabetes was the standard practice as early as 1934 1 and was also used in the hyperglycemic emergency diabetic ketoacidosis 2. Errors and poor outcomes with sliding scale insulin dosing studies demonstrate and experts agree that there is little evidence for using only sliding scale insulin to control blood glucose 10 24 25 a number of published articles have also focused on the problems associated with sliding scale insulin. You still need to count carbohydrates.

Obtain venous blood sample for u e s to include potassium and. Sliding scales are less effective in covering a pre meal high blood sugar because the high blood glucose correction and food bolus cannot be split. Continue basal insulin may need to re adjust dose 6 7 8 rapid acting insulins should be just before meal. For many years each hospital has had its own way or in many cases several ways of managing in patients with high glucose levels.

Disadvantages of the sliding scale regimen. Insulin medication errors hyperglycemia practice guidelines sliding scale insulin ssi is commonly used to manage hospitalized patients with and without diabetes mellitus 1 2 3 monotherapy with ssi often leads to erratic fluctuations of glucose control because it tries to retrospectively treat hyperglycemia rather than prospectively prevent it 1 4 5 6 7 8 9 10 in the.