I’ve seen several patients doing using a sliding scale of 70/30 insulin. Is it logical? I even saw a 70/30 sliding scale every six hour order today, but given the duration of action of NPH, is this dangerous?

There are almost as many ways of using insulin as there are patients. However, sliding scales are a particularly North American phenomenon, and I certainly have no experience of using 6 hourly 70/30.

The principle of therapy is to try to lay down a background of insulin on which are placed boluses to cover mealtimes. In this regard, such a regimen is quite logical but, I agree that there may be a risk of accumulation of isophane.

KJR

[Editor’s comment: If this occurred in a hospital, I’d think that the doctor writing the order for a “sliding scale” of 70/30 insulin should be quietly and politely, but firmly, asked if it were a mistake, and the order was supposed to be for either Regular or lispro insulin. If the doctor insists on the order as described, and can’t explain the usage, I’d think the next step would be to bring the issue to the attention of either the pharmacy, the Chief of Medical Staff, or the hospital’s Risk Management department. Insulin is a potentially dangerous drug, and inappropriate orders can provoke life-threatening hypoglycemia in patients who are hospitalized, and who may not be eating well and not mentally alert.

WWQ]