January 21, 2003
Daily Care, Insulin Analogs
Question from Detroit, Michigan, USA:
My endocrinologist has left to practice in another country, and before she left, she started me on the NovoLog plus Lantus routine. Our next step was to work on the sliding scale, but it never happened, and I'd like this information to give to my internist who is going to work with me on this. What is the formula for the sliding scale when you use NovoLog for short-acting and Lantus for basal? I also use metformin.
If you have already calibrated the Lantus (insulin glargine) dose to your before breakfast fasting blood sugar, there should be no need to change that. Devising flexible insulin dosing for the NovoLog is rather more complex.
First of all, the insulin can be given just after the meal so that the dose can be adjusted for amount of carbohydrate actually consumed which involves learning how to carb count and how many grams of carbohydrate justify how many units of insulin. You may need the help of a dietitian to learn how to do this.
Secondly, it is usual to add a correction factor of one unit of insulin for every 50 mg/dl [2.8 mmol/L] of blood sugar above 150 mg/dl mg/dl [8.3 mmol/L]. Emphasis is also placed on to the two-hour postprandial blood sugars which can lead to further modifications the next day or even to another injection. All of this will seem outrageously demanding to begin with, but most people in your age range adapt quickly, and it can lead to very good control as you learn to adapt it for the vagaries of exercise and other factors.
[Editor’s comment: You may find the book, Stop the Rollercoaster by John Walsh and Pat Roberts extremely useful is learn how to manage this insulin regimen effectively.