The toughest thing here is that the 1800/(home insulin) = ISF ASSUMES that the home regimen is resulting in normal glucose levels. The trouble is that they often are not well controlled and this is why we see them in the hospital. I think a great tutorial would running a scenario where you have a poorly controlled diabetic and explaining how to work out daily requirements.
As a Type 2 Diabetic I have found the sliding scale useless. Two major issues must be addressed; the patient's weight and grams of carbohydrate intake. You cannot determine the level of insulin resistance if you don't know the patient's weight. Weight will also determine the ratio of insulin to carbohydrates. A man that weighs 250 lbs will be more insulin resistant than a man that weighs 180 pounds. The heavier individual will also need more insulin to cover say 25 grams of carbohydrates. There are charts that explain insulin resistance. If the two men noted above have a blood sugar of 300, the heavier man will need more insulin to drop the sugar to 150, than the lighter man.
The sliding scale is not a one size fix all. I am high insulin resistant and try to keep my blood sugar levels between 100 and 130. In order to maintain this level, I need 10 to 20X the amount indicated by the sliding scale in relation to my blood sugar. Also I am 6'5" and weigh 230 way over the size the sliding scale was calculated for. I wonder if any others have had the same problems I have had with doctors managing my blood sugar levels I have had in a hospital situation?
I have the same problem. I cannot find a sliding scale that I need. I take 100 units of Lantus at night and between 30-40 units of Humalog Kwikpen before meals. I either go too low at night or I am too high. I never get a nice normal blood sugar reading. I have had diabetes for at least 24 years (Type 2). My PCP is not helpful at all. I need to get a good endocrinologist. I am a 5'7", 170 lb. woman and I am actually afraid to go get a A1C since the doctor then blames me for not maintaining normal blood sugars and looks at me like I'm an idiot. He gives me no help whatsoever and he wants me to try these newfangled insulins that have been brought to market without proper testing and can cause deadly side effects. I will not do that. I take Lantus and Humalog Kwikpen and I also take Metformin since I have polycystic ovarian syndrome. Does anyone else have this problem? I rarely eat 3 meals a day. Usually, I have something in the morning like hard boiled eggs and coffee, no lunch, and a normal dinner.
@@mclacek5 Yes both comments are right.I am super resistant also.I try to eat low carb with total of 900 cal a day.Most meals I have to use 40 units u-100 to keep my numbers close to 200 after meal.I use 180 units a day.According to this scale it would drop my numbers by 400 points.No way even close.Sorry peeps but the scale is cookie cutter medicine-one size fits all!! NOT.
![Long acting vs Meal-time vs Sliding scale insulin [UndergroundMed]](http://i.ytimg.com/vi/lpHJP-oaLvI/mqdefault.jpg)
![Long acting vs Meal-time vs Sliding scale insulin [UndergroundMed]](/img/tr.png)
Great video, very informative and helpful. No one really ever explained it properly when working in the wards so thank you for that.
The toughest thing here is that the 1800/(home insulin) = ISF ASSUMES that the home regimen is resulting in normal glucose levels. The trouble is that they often are not well controlled and this is why we see them in the hospital. I think a great tutorial would running a scenario where you have a poorly controlled diabetic and explaining how to work out daily requirements.
As a Type 2 Diabetic I have found the sliding scale useless. Two major issues must be addressed; the patient's weight and grams of carbohydrate intake. You cannot determine the level of insulin resistance if you don't know the patient's weight. Weight will also determine the ratio of insulin to carbohydrates. A man that weighs 250 lbs will be more insulin resistant than a man that weighs 180 pounds. The heavier individual will also need more insulin to cover say 25 grams of carbohydrates. There are charts that explain insulin resistance. If the two men noted above have a blood sugar of 300, the heavier man will need more insulin to drop the sugar to 150, than the lighter man.
what if you don't know how much home insulin they are on? Then how do you approach the sliding scale?
thank you straight to the point!
يا شبابنا المسلم وثم العربي هاهي المعرفة ميسرة لكم فأغتنموا الفرصة ونظموا وقتكم وشمروا على سواعدكم
Very nice , easy explanation , thanks very much ...
keep on .....
Very useful video , thx for ur excellent presentation.
The sliding scale is not a one size fix all. I am high insulin resistant and try to keep my blood sugar levels between 100 and 130. In order to maintain this level, I need 10 to 20X the amount indicated by the sliding scale in relation to my blood sugar. Also I am 6'5" and weigh 230 way over the size the sliding scale was calculated for. I wonder if any others have had the same problems I have had with doctors managing my blood sugar levels I have had in a hospital situation?
I have the same problem. I cannot find a sliding scale that I need. I take 100 units of Lantus at night and between 30-40 units of Humalog Kwikpen before meals. I either go too low at night or I am too high. I never get a nice normal blood sugar reading. I have had diabetes for at least 24 years (Type 2). My PCP is not helpful at all. I need to get a good endocrinologist. I am a 5'7", 170 lb. woman and I am actually afraid to go get a A1C since the doctor then blames me for not maintaining normal blood sugars and looks at me like I'm an idiot. He gives me no help whatsoever and he wants me to try these newfangled insulins that have been brought to market without proper testing and can cause deadly side effects. I will not do that. I take Lantus and Humalog Kwikpen and I also take Metformin since I have polycystic ovarian syndrome. Does anyone else have this problem? I rarely eat 3 meals a day. Usually, I have something in the morning like hard boiled eggs and coffee, no lunch, and a normal dinner.
@@mclacek5 Yes both comments are right.I am super resistant also.I try to eat low carb with total of 900 cal a day.Most meals I have to use 40 units u-100 to keep my numbers close to 200 after meal.I use 180 units a day.According to this scale it would drop my numbers by 400 points.No way even close.Sorry peeps but the scale is cookie cutter medicine-one size fits all!! NOT.
For how much taking every day, do you mean the long lasting basal dose or basal plus fast acting units taken with each meal combined?