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Frequent Advisor
cdlefevre
Total Posts: 142
Registered on: ‎07-25-2011

Sliding Scale

To start the doctor has me on the sliding scale for my Apidra.  I know this is not ideal but she says we will dial it in more as I get more comfortable with it.  From what I understand I should test and then use the chart she gave me to determine the number of units of insulin to inject.  My question is, when do I test to determine what dose to take?  Is it at meal time, an hour after, at my peak?  So far I have been testing about an hour after meal time and then dosing from that number but It has been putting me on the low side.

Craig

T1
Dx 7/19/2011 A1C 10.7 as Type 2, started Metformin
12/16/2011 A1C 6.3
3/17/2012 A1C 8.5- changed to Janumet
6/14/2012 A1C 7.2
11/16/2012 A1C 14.4
Started basal insulin-11/20/2012
1/21/2013- Diagnosis changed to Type 1, started fast acting insulin
Advisor
ronin1966
Total Posts: 223
Registered on: ‎10-08-2012

Re: Sliding Scale

Nope!:smileysad:

 

Insulin (sic. and testing) taken just before you eat, so the insulin is on board BEFORE our sugar spikes.

 

If you inject after the meal, the bloodsugar, and the breakdown of whatever food(s) we eat already has a head start, and we are forced to play BG "catch-up". An unpleasant if perhaps benign game.

 

Testing TWO hours after eating, will give you a hint if you guessed the coverage, the food (everything) correctly.

 

Waiting an hour after the meal before shooting/testing (if you can do so before hand) is very similar to catching a rocket AFTER it left the launch platform. You want to have the insulin onboard to reduce the BG spike food will provide is a better approach.

Merely my opinion, I could surely be mistaken

J
T1
Frequent Advisor
harleydeuce
Total Posts: 206
Registered on: ‎10-31-2009

Re: Sliding Scale

Tell the Dr. that you need to ditch the sliding scale now and start with carb counting. A sliding scale is only good for corrections when your numbers are over your target. Using an insulin to carb ratio is what you should be doing with carb counting to make your life easier.  A base would be to start with a ratio of 1 unit of insulin to 10grams of carbs. So if you eat a 30gram meal you would need 3 units of insulin. You would take your reading before you eat, say you are at 100 and on your target you would take the three units with the meal and recheck a couple hours later. Then if say you counted wrong and your number was lets say for arguement 180 you would then use a sliding scale to correct the higher number. For instance for me if I am up to 150, 1 unit will bring me down 50 points and I'm back in range. Say from 150 to 200 I need two units to bring me back in range and say from 200 to 250 I need six units. That is about the only good a sliding scale can be. Very antiquated for dosing for meals and again I suggest you get with your dr or a get into an actual CDE to learn the carb counting. If you do it right from the start you are way better off.

Established Advisor
sis59
Total Posts: 933
Registered on: ‎12-12-2009

Re: Sliding Scale

The problem with the sliding scale is the amount of insulin suggested, based on your blood sugar, does not take into account the amount of carbs that you will be eating.  You might be fine if you only eat a green salad with vinagrette dressing and no croutons, but otherwise depending on what you eat your blood sugar may soar and take hours to bring back down.  You will need to learn to count carbs and use an insulin to carb ratio to determine how many units of insulin to take to accomodate x number of carbs being consumed.  You will also need a correction factor to determine how much one unit of insulin will drop your blood sugar.  Until you learn to do these things, you will always be playing catch-up with high blood sugars, so hopefully your doctor will have you meet with a dietician or certified diabetes educator soon to get you started on counting carbs.  In the meantime, like ronin suggested, take your insulin before you eat, and test two hours later to correct any high blood sugars.



-Sue
Type 1, diagnosed at age 38
OmniPod pump using Apidra insulin
Dexcom CGM

My adult son was diagnosed type 1 at age 4
MiniMed Revel pump and CGM
Apidra insulin
Established Advisor
sis59
Total Posts: 933
Registered on: ‎12-12-2009

Re: Sliding Scale

harley,

 

Good to see you back!



-Sue
Type 1, diagnosed at age 38
OmniPod pump using Apidra insulin
Dexcom CGM

My adult son was diagnosed type 1 at age 4
MiniMed Revel pump and CGM
Apidra insulin
Frequent Advisor
harleydeuce
Total Posts: 206
Registered on: ‎10-31-2009

Re: Sliding Scale

I figured I haven't been back in while I might as well see whats new and throw my $0.02 in where I can.

trisha01
Total Posts: 6,425
Topics: 316
High Fives: 709
Blog Posts: 62
Solutions: 74
Registered on: ‎10-31-2009

Re: Sliding Scale

[ Edited ]

Ditto to what Sue said, Harley! Hope you come around even more. Have you finished building the new house?

 

Trisha

edited cause I forgot to put HD's name in




Trisha

IDDM (Type 1 Autoimmune) 30+ years ~ Currently using MDI & Minimed CGM ~
Check out my diabetes blog!

  All brittle means, is that one has great fluctuations, which is pretty much hallmark for Type 1's. Some more so than others. - me
  First light brings a new day, new hope, new wisdom, and a chance to start fresh again. - me

If everyone were dealt the same amount of cards, there would be no challenges in life. Challenges are part of life's lessons, to teach us to grow in all aspects, and to learn what we need to learn, to make it in this world. Life was not meant to be fair. -me



~ New Type 1 Info ~ Insulin, Test Strips, Lancets, and other meds ~ Kidney Damage Info ~


trisha01
Total Posts: 6,425
Topics: 316
High Fives: 709
Blog Posts: 62
Solutions: 74
Registered on: ‎10-31-2009

Re: Sliding Scale

Craig,

 

In addition to what the others have said, .... Apidra is the fastest of the three fast acting insulins. It is usually in and out at about 3 to 3-1/2 hours. It can also have a nasty tail, so be careful when you do start correcting. Up in the "Tips, Terms, etc...." sticky, is an insulin action chart. You might want to take a look see at it. Apidra is called "insulin glargine" (sp?) in the chart.

 

Trisha 




Trisha

IDDM (Type 1 Autoimmune) 30+ years ~ Currently using MDI & Minimed CGM ~
Check out my diabetes blog!

  All brittle means, is that one has great fluctuations, which is pretty much hallmark for Type 1's. Some more so than others. - me
  First light brings a new day, new hope, new wisdom, and a chance to start fresh again. - me

If everyone were dealt the same amount of cards, there would be no challenges in life. Challenges are part of life's lessons, to teach us to grow in all aspects, and to learn what we need to learn, to make it in this world. Life was not meant to be fair. -me



~ New Type 1 Info ~ Insulin, Test Strips, Lancets, and other meds ~ Kidney Damage Info ~


Frequent Advisor
cdlefevre
Total Posts: 142
Registered on: ‎07-25-2011

Re: Sliding Scale

Thanks everyone. I think the doc is going to start tailoring it more for me at my next appt in a couple weeks. I would love to see a CDE but my insurance doesn't cover it, at least it didn't last year but we did switch carriers this year
Craig

T1
Dx 7/19/2011 A1C 10.7 as Type 2, started Metformin
12/16/2011 A1C 6.3
3/17/2012 A1C 8.5- changed to Janumet
6/14/2012 A1C 7.2
11/16/2012 A1C 14.4
Started basal insulin-11/20/2012
1/21/2013- Diagnosis changed to Type 1, started fast acting insulin
trisha01
Total Posts: 6,425
Topics: 316
High Fives: 709
Blog Posts: 62
Solutions: 74
Registered on: ‎10-31-2009

Re: Sliding Scale


trisha01 wrote:

Craig,

 

In addition to what the others have said, .... Apidra is the fastest of the three fast acting insulins. It is usually in and out at about 3 to 3-1/2 hours. It can also have a nasty tail, so be careful when you do start correcting. Up in the "Tips, Terms, etc...." sticky, is an insulin action chart. You might want to take a look see at it. Apidra is called "insulin glargine" (sp?) in the chart.

 

Trisha 


 

 

I made an error, which is highlighted in red just above. Apidra is "insulin glulisine". My g's were mixed up! Sorry about that.

 

Trisha

 




Trisha

IDDM (Type 1 Autoimmune) 30+ years ~ Currently using MDI & Minimed CGM ~
Check out my diabetes blog!

  All brittle means, is that one has great fluctuations, which is pretty much hallmark for Type 1's. Some more so than others. - me
  First light brings a new day, new hope, new wisdom, and a chance to start fresh again. - me

If everyone were dealt the same amount of cards, there would be no challenges in life. Challenges are part of life's lessons, to teach us to grow in all aspects, and to learn what we need to learn, to make it in this world. Life was not meant to be fair. -me



~ New Type 1 Info ~ Insulin, Test Strips, Lancets, and other meds ~ Kidney Damage Info ~