[Previous Months][Date Index][Thread Index][Join - Register][Login]
[Message Prev][Message Next][Thread Prev][Thread Next]

[IPk] Re: sliding scales

Hi all,

I've not been around for a while as we've had problems with our e-mail
system (probably  my fault - oops) and am responding to the e-mail of 27th
Oct, so please excuse me if my response has already been covered.

John, the sliding scale to which you refer relates to the total insulin
requirement per day.  It doesn't have any relevance to the experience of
many diabetics, which is that when your bg goes up you need more insulin to
get it down, as Carmel infers and explains.  Not sure I agree, but I don't
know the answer...  Personally, with a bg of less than 10 mmol, 0.1 unit
drops my bg by 1 mmol; over about 12, I need more, and it's variable - if I
have a bad site and my bg goes up to 20 (or more) mmol, I can need several
units to drop it to below 10 mmol (I'd normally go hypo with this dose) and
can see a factor of 5-10 coming into play. This causes problems as I can
never tell exactly what factor to use (so would risk a mega-hypo if I used
too much) and I really don't want to experiment too much for obvious
reasons! - so I have to do it gradually, and the day is effectively caput.

Ideas very welcome!

> Date: Fri, 26 Oct 2001 11:49:35 +0200
> From: John Neale <email @ redacted>
> Subject: RE: [IPk] Sliding scale vs. pumps
> >Would someone clarify what "sliding scale" means.
> Thanks for having the courage to ask :-)
> I just did a google on "insulin sliding scale" and found this:
> http://www.diabetesnet.com/diabetes_control_tips/1800rule.html
> (Beware! This is a US site, using US bg units. Divide by 18 to get UK
> Essentially it is the pretentious medical name for estimating out how far
> so much rapid acting insulin will lower your blood glucose level. It's
> a ratio. Mostly used when you are actively managing your bg level. Also
> known as insulin sensitivity factor. Mine is 2.5 mmol/L per unit.
> I say estimate, as I believe it is not that accurate. It's all a best
> guess. Many believe that the higher your bg, the less sensitive you become
> to insulin - so you need more insulin to reduce your bg from 16 to 12 than
> you would need to go from 10 to 6. Why this is so is almost unanswerable.
> Is your body not absorbing very well today? (You inject 4 units, but only
> make it to the blood stream. The other unit is carted off by the immune
> system) Is that why your bg is high in the first place? Is it absorbing
> very slowly today? (So the insulin will hit you in 6 hours, rather than 1)
> Are you going down with a cold so you need more insulin in any case? (And
> so the ratio you use may be inappropriate today in any case) Is your
> digestion going slowly today? (So at 7pm your lunch carbohydrate is only
> just hitting you). The list of reasons is endless. The important thing is
> not to take too much! And be patient.
> John
> - --
> mailto:email @ redacted
> Date: Fri, 26 Oct 2001 14:12:41 +0000
> From: "Carmel Matthews" <email @ redacted>
> Subject: RE: [IPk] Sliding scale vs. pumps
> Sliding scale insulin therapy is generally used when people with diabetes
> who take insulin are  unable to absorb insulin or food in the usual way.
> When you are ketoacidotic you become dehydwated as all the body fluids are
> being passed out in the urine.The pottassium levels become depleted so
> are replaced along with the fluid by intravenous infusion. The insulin
> not be absorbed so well as the circulating blood thickens and is more
> sluggish which is why the insulin pump may be temporarily discontinued. If
> you continue the pump whilst in this state, once you are rehydrated you
> sometimes get a crashing hypo as the circulatory sysyem gets into gear
> again. Also they do not generally bring the glucose back to absolute
> ie having been in a state of ketoacidosis 98mmols would be accepyable fopr
> the same reason until you start your previous therapy whether it be pump
> MDI. The aim is not to stabilise you on IV insulin but to correct the
> state the illness has caused. In theory all of us on pumps are treating
> diabetes with a sliding scale as we match the dose to food actinity etc
> Carmel
for HELP or to subscribe/unsubscribe, contact: HELP@insulin-pumpers.org
help SUPPORT Insulin Pumpers http://www.insulin-pumpers.org/donate.shtml