Insulin Sliding Scale Generator
Generate low, standard, or high-dose subcutaneous insulin sliding scales for inpatient blood glucose management. Customizable for individual patient sensitivity.
Sliding Scale — Standard / Moderate
Order: Subcutaneous Regular Insulin — Check fingerstick glucose before meals & bedtime
| Blood Glucose | Insulin Dose (subcutaneous) |
|---|---|
| <70 mg/dL | Hypoglycemia — Treat with 15g oral glucose / 25 mL D50 IV. Recheck in 15 min. |
| 70-149 mg/dL | 0 units (no correction) |
| 150-199 mg/dL | 3 units |
| 200-249 mg/dL | 6 units |
| 250-299 mg/dL | 9 units |
| 300-349 mg/dL | 12 units |
| 350-399 mg/dL | 15 units |
| ≥400 mg/dL | 18 units + call physician + ABG, ketones, anion gap |
ICU + ward diabetes management, charted automatically
EasyClinic's inpatient module logs every fingerstick, every insulin dose, every hypoglycemic event — and graphs glucose trends across nursing shifts. Built for India's diabetic load.
Also Known As
When to Use a Sliding Scale
Sliding scale insulin (SSI) is appropriate as supplemental correction alongside scheduled basal-bolus insulin in hospitalized patients. It is NOT recommended as sole therapy for diabetic inpatients because it leads to wide glycemic excursions and worse outcomes.
Common scenarios: post-operative patients (especially diabetics), TPN recipients, steroid-treated patients, NBM patients with type 2 diabetes, and as starting therapy in newly-diagnosed inpatient hyperglycemia.
Choosing Insulin Sensitivity (Scale Intensity)
- Low dose: Type 1 diabetes, elderly, BMI <25, eGFR <30, frail/cachectic patients, prior severe hypoglycemia
- Standard: Most type 2 diabetics, BMI 25-30, normal renal function, no significant prior insulin therapy
- High dose: Insulin resistant, BMI >30, on systemic corticosteroids (prednisolone >10 mg/day), TPN, sepsis, prior insulin requirement >0.5 units/kg/day
Glycemic Targets in Hospital
- Critically ill (ICU): 140-180 mg/dL (avoid <110)
- Non-critically ill ward patients: <140 fasting, <180 random
- Pregnant diabetics: Tighter — <95 fasting, <120 1h post-meal
- Hypoglycemia threshold: <70 mg/dL = treat. <54 mg/dL = severe.
Frequently Asked Questions
▸Why is sliding scale insulin alone inadequate?
It only reacts to existing high glucose, doesn't prevent it. Causes glycemic swings, worsens outcomes. Always combine with basal insulin (glargine, detemir, NPH) for sustained control.
▸How do I transition from sliding scale to basal-bolus?
After 24-48 hours, sum total daily insulin used. Give 50% as basal (glargine HS), 50% as bolus (split before meals). Continue corrections as needed.
▸Should diabetic patients fast for surgery be on sliding scale?
Yes — hold oral hypoglycemics, give 50% of usual basal insulin, monitor q4h, correct with sliding scale rapid-acting insulin while NBM.
▸How often should I check glucose?
Eating patients: q-meals + bedtime (4x/day). NBM patients: q4-6h. ICU/insulin drip: q1-2h. Sick day diabetes: q2-4h with ketone monitoring.
▸What if my patient is on a steroid taper?
Steroid-induced hyperglycemia is dose-dependent and worst 4-12 hours post-dose. Use higher sliding scale, add basal insulin, expect dose reduction as steroid tapers.
References
- American Diabetes Association. Standards of Care in Diabetes — 2024
- Endocrine Society Clinical Practice Guideline: Management of Hyperglycemia in Hospitalized Patients (2022)
- RSSDI Guidelines on Inpatient Diabetes Management (India)
Manage diabetes longitudinally, not just episodically
EasyClinic stores every HbA1c, every glucose log, every insulin dose change, and every hypoglycemic episode. Generate insulin titration recommendations from history — no more guessing.