Insulin Sliding Scale Guidelines

Sliding Scale Insulin Framework

The American Diabetes Association recommends a simplified sliding scale approach while adjusting prandial insulin therapy with Humalog (insulin lispro) 1, 4
For premeal glucose >250 mg/dL (>13.9 mmol/L), administer 2 units of Humalog 2, 5
For premeal glucose >350 mg/dL (>19.4 mmol/L), administer 4 units of Humalog 2, 5
Discontinue sliding scale when not needed daily 1, 5
Do not use rapid-acting insulin like Humalog at bedtime due to risk of nocturnal hypoglycemia 1, 3

Monitor blood glucose before meals and at bedtime to guide insulin administration 3
Adjust the sliding scale every 2 weeks based on fingerstick glucose patterns 1, 5
Target premeal glucose levels of 90-150 mg/dL (5.0-8.3 mmol/L) 1, 3
If 50% of premeal glucose values over 2 weeks exceed target, increase the insulin dose 1, 5
If >2 premeal glucose values per week are <90 mg/dL (<5.0 mmol/L), decrease the insulin dose 1, 3

Hypoglycemia risk increases with sliding scale insulin, particularly in older adults 1, 5

Consider higher glucose targets (90-150 mg/dL) to avoid hypoglycemia in older adults or those with complex medical needs 1, 5
In hospitalized patients, basal-bolus insulin regimens with supplemental sliding scale may be more effective than sliding scale alone 6, 7
For patients on enteral/parenteral nutrition, add 1 unit of insulin per 10-15g of carbohydrate in addition to sliding scale coverage 7
For patients with mild diabetic ketoacidosis, consider a priming dose of 0.4-0.6 units/kg followed by 0.1 unit/kg/hr before transitioning to sliding scale 8