Unexpectedly Intriguing!
May 23, 2011

From a discussion forum on the Diabetes Daily web site, on the topic of Sliding Scales, which is a kind of regimen recommended by general practitioners (GP) that many diabetics follow to manage their blood glucose (BG) levels throughout the day:

robcon: Why do some people not like sliding scales in the world of Diabetes management ?

coravh: Because typically they are less precise. I know the ranges my doc gave me first of all didn't work and secondly were too large. For example, from 150 to 200 take x units. It's much more precise (especially when pumping) to know your correction factor (aka insulin sensitivity). In my case, 1 unit brought me down 80 points. So I can actually calculate exactly how much to take based on a precise glucose measurement and not use a one size fits all sliding scale used by docs everywhere.

That's my take on it anyway.

Stump86: Adjusting insulin based on carbs and BG level tends to be more effective at controlling your BG levels than a sliding scale. While sliding scales can be personalized they tend to be one size fits all, and with D, nothing is one size fits all. Being able to adjust your doses is pretty important for success. Unless you always eat and do the same things, a little bit of flexibility is desired, and often necessary, and sliding scales don't always offer that.

Gord: Was in hospital in January for open heart surgery. Endo in hospital decided I should go on Insulin.........no problem with that since my GP and I were already in agreement before surgery.

Problem came when Endo gave me a fixed dose of Lantus daily and a sliding scale of Novolog based upon what my bs reading was PRIOR to meals.

No account was made for what I was about to eat.

Needless to say, I found my PP bs readings all over the place..........hypos due to too much Insulin was worst case.

My GP told me to start "tweaking things" to see what happened.

When I took control and started bolusing to my meter AND what I was about to consume, readings became much more stable.

Jollymon: Maybe some people don't like sliding scales becuase they can't do the math? Or maybe they don't want to count the carbs. I really don't know why because they work for me.

Larry007: My endo gave me a sliding scale and my numbers are all over the place. I worked out 1u/17 for my cf but still find it hard to bring the sugars down. This is very frustrating. The sliding scale is worthless from what i have experienced. i just hope it gets better before i start losing toes and other digits.

aloha: Oooh... I hated using the sliding scale method, numbers ALL over the places, highs, lows, highs followed by abrupt lows, and vice-versa. The scale does not take into account what you are eating, how many carbs, how active or lazy your are going to be, types of carbs (and yes, for me it makes a differnce) the "stacking of insulin", oh my, lots of things that just made it work so poorly for me!
I use a handy dandy calculator (scroll down the page a bit, it;s there!) to help me figure out insulin per carbs, and all kinds of extras, and it helps a lot!

deanusa: very interesting calculator.

aloha: I LOVE that calculator Dean, it has made my life so much easier. with that being said though, you still need to know aproximently how much each unit of insulin lowers your gl, as well as how many carbs you can cover personally with each unit, because you know it is different with every person, and, even with the same person at different times of the day! I do love that it does take into consideration your starting number as well as how active you will be. To be honest, that calculator litterly changed my life1 Smiley
Can you tell I LOVE it? lol

Lloyd: With sliding scale, you are correcting for highs, rather than preventing them from happening.

Not bad for an hour and 19 minutes of our time one morning a couple of years ago, although the real credit should go to Neil Bason, who developed the math behind the tool and who considered so many of the things that ought to be taken into account for such a calculator.

But still, we're happy to find that it's being very well-received by those for whom we suspected would benefit from such a tool, and we thank all of you for making our day today!

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