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Experience with sliding scales ?

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Cleo

Well-Known Member
Relationship to Diabetes
Type 1
Ive been booked in for a c section and need to have ante natal steroids administered beforehand to help with baby's lung development. The steroids tend to make you insulin resistant so I need to be an in patient for 48hrs (hopefully not more!) so they can monitor my BGs. They've said that I can inject my Levemir but that I'll need to have the QA insulin administered via a sliding scale.

So - I was wondering does anyone have any experience with this ? If so how did it go ? Pros, cons etc ? I've tried to look up info online but haven't found much . I'm on MDI and I'll be the first to admit that I like having the autonomy of managing my own T1 esp -- when I'm pregnant. I'm sure the hosp staff are well trained but it's my body and my baby 🙂. So I guess I'm just trying to understand the benefit of having someone else manage my condition and why the sliding scale is better than what I'm doing now.

Thoughts appreciated !
Thanks
 
I have been on a sliding scale. We are all different so it works better for some people than others. If you are diabetic and have to fast before any kind of op they don't want you to be too high or too low so you are given a big bag of dextrose and a tube of insulin. You are then monitored every hour to make sure your sugars are doing what they should be doing and if not the scale is adjusted accordingly. I had mine because I had to fast for a very long time to have toes amputated, so am not sure how it will work for a c section.

I think the sliding scale is just a precaution on their part because you will be nil by mouth prior to any op and you need to keep things like fluids going in and glucose levels under control.

Hope this is of help and reassurance and all will go well for the birth.
 
A sliding scale is usually combined with intravenous saline and glucose, so that if you have to be kept nil by mouth or feel sick so can't eat, the staff can help you keep control of your blood glucose levels. You're right that taking steroids (for any reason, whether to treat your baby before it's born, or yourself for other issues such as some types of asthma or arthritis, for example) can raise blood glucose levels, so higher than normal doses of insulin may be needed.
Hope all goes well and you won't be in hospital any longer than you and baby need.
 
Thanks for your response Caroline.
Sorry - I wasn't clear in my post. They have said that the sliding scale is only for dealing with the Highs as a result of the ante natal steroids which will be administered on a Friday. The c section itself isn't until the following Wednesday.
 
Well actually - it's like being on a pump 'for the duration' - insulin is usually 500u/ml Actrapid - which funnily enough not only acts rapidly LOL - because it's administered intravenously - it gets there even quicker!

So - ask how often they will do your BG and what BG they are aiming to correct you to - those are the important things here - not 'How' they achieve it !
 
I was on a sliding scale for a spinal op. I asked about how often they would check my BG and was reassured that they would keep a check. I went into the op with BG 6.2 and came out at 5.8 in the recovery room. I stayed on the scale for the next 4 hours whilst I was sick after the anaesthetic and they kept my levels steady in spite of the pain and sickness. Once i was keeping food down I eventually went back onto the pump but forgot to prime the new cannula so went up a bit, and it took a bit of time to work out what temporary increase in insulin I needed.

I asked questions from the start and they explained as they changed my rate of flow for glucose and insulin. These will always go up together as they need to be able to match the flow of each to keep things steady. I was so pleased that I did not have to do any thinking about adjustments after the op and was well cared for on the sliding scale.
 
Many thanks all - very helpful
SB - good to hear that you had a positive experience with it
Trophy- they've said they'll correct if I'm above 8mmol, but I'll ask how often they're going to check my BGs as they haven't clarified that yet. I'm on MDI and I suspected that the sliding scale works similar to a pump (which I'm unfamiliar with) so the "how" they achieve it is important to me as otherwise I can't challenge / ask questions about anything that they do.
 
Hi Cleo, I had a sliding scale when I had a hysterectomy and needed IV steroids for about 5 days at about 100mg every couple of hours due to my Addison's disease. The only problem I had was trying to get the staff to understand that due to the steroids being administered I needed the extra insulin before the steroids hit the blood stream. Once the in-patient DSN was called in she sorted the problem straight away and all was fine. So please don't worry, everything will be fine.
 
Slding scales are used for a variety of reasons. I had mine because I had to fast for a long time pre op and the idea was to keep my hydrated because I was nil by mouth and to avoid being too high or two low.
 
I was on a sliding scale for around 5 days during and post op this January (went into A&E and had emergency bowel surgery - so not planned!). If you had asked me before hand how I would have felt having other people manage my insulin, test my blood etc I would have felt uncomfortable and a bit worried. I have to say the whole experience was very well managed and it was a great relief not to be having to worry about it myself. My levels were managed very well and to be honest (although not relevant in your case) I wouldn't have known how to look after myself with regard to my diabetes as I wasn't eating and was on a lot of pain relief - so very different to my normal daily life! I am on MDI also.
 
Cleo said:
They've said that I can inject my Levemir but that I'll need to have the QA insulin administered via a sliding scale.
Click to expand...
Rereading your post I suspect you will be having a very high dose of steroid if taken by mouth, having it IV reduces the amount needed thus the amount of insulin as well. I have a neurological condition that if flares will need something like 500mg of pred for 5 days in a row this works out to about a months worth of insulin each day 😱 Obviously very dangerous as well hence DSN told me to ring and they would have me in and administer the lot via IV as the amount needed would be substantially reduced and also a lot safer for me.
 
Good luck, Cleo. 🙂
 
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