Makomed's Weblog

No Sliding for Humalog 70/30

Posted on: August 18, 2009

ME:  “Hi, I’d like to confirm patient X’s sliding scale orders for his humalog insulin?”

DOCTOR’S SECRETARY:  “Is it humalog 70/30 units?”

ME:  “Correct.”

SECRETARY:  “Humalog 70/30 doesn’t come in a sliding scale.”

I did not know that. Apparently, the only insulin where the sliding scale applies is Novalog. However, it seems common knowledge that Novalog and Humalog aren’t all that different from each other. (There’s a PubMed article stating that one is only slightly faster in absorption but I gotta go find it).

Bottom line: To avoid confusion and looking stupid, mention Novalog only when you’re asking about a sliding scale. Humalog will be given to the patient BID regardless of the outcome of the blood sugar.

But don’t take my word for it.

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1 Response to "No Sliding for Humalog 70/30"

No “sliding scale” for ANY mixed insulins

Regardless of the insulins’ trade name, NO “Mix” or split type insulin is EVER used for bolus injections.

Sliding scale is a technique used only for calculating bolus injections, and intended for use by an educated and motivated type 1 patients interactively managing BG through MDI or pumps. Such patients do not use premixed insulins.

A basal or a total daily dosage change is not done on a sliding scale, but by a fixed amount when long term fasting levels are consistently above or below the target range. These changes are generally made at the direction of a physician for type 2 diabetics or stable type 1 patients who are not actively involved in managing their own BG.

If a physician _and_ the patient don’t both clearly understand the difference between basal (long term) and bolus (short term) insulins, they shouldn’t even be talking about sliding scale.

Attempting to use the sliding scale technique without understanding the basic principle is more likely to destabilize BG than to improve control.

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