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Sliding scale in hospital

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Dasroots

Well-Known Member
Relationship to Diabetes
Type 1
I'm currently in HDU with bad asthma so they have put me on a sliding scale of insulin. Today the consaultant told me not to take my levimer as I was having regular quick acting. Anyway just had a hypo, it dropped so quickly. I started feeling hungry so I tested I was 4.9 so I asked the nurse if I could eat. I then started sweating I tested four minutes later and I was 3.8. I ate 13bisckets and I'm now around 5mmol. I made them turn off the sliding scale. Normally I would have two bisckets and be fine but I came over so hungry. I could eat more now. No clue what's going on, I've had less steroids today so my insulin requiments would be less. Feeling very stressed. When I'm in with my asthma my DM goes up the spout.
 
If you're tending to go hypo, surely the rate at which you're being fed insulin should be turned down accordingly? :confused: That after all is surely the point of being on a sliding scale, especially in a HDU where IIRC you're supposed to be monitored more closely than on a regular ward (though not quite as much as on an ICU)...

I hope it gets sorted soon.
 
From my limited experience with a sliding scale the nurses are supposed to adjust it according to your numbers. I Hope things improve for you soon
 
I made them take me off of it this morning as the nurses where clueless. I also refused to give in my insulin the registra wasn't happy but the consultant understood. Now I'm in charge of my diabetes instead of nurses who don't know.
 
They've done this to me a couple of times when I've been carted in with one lurgy or another and it's always been a right royal ****-up. I've ended up having to call the Diabetic Consultant to come and sort them out because the nurses were always too busy to test properly and never listened when I'd say I was hypo - oh and they wouldn't let me test myself either. Last time round, I flatly refused to let them manage things and insisted on doing it myself... That required another call to the consultant, but they let me get on with it in the end. Next time, if there is a next time, I'm going to call him before I go in so he can head them off at the pass. I hope you're better soon and back home where it's safe.
 
Dasroots said:
I made them take me off of it this morning as the nurses where clueless. I also refused to give in my insulin the registra wasn't happy but the consultant understood. Now I'm in charge of my diabetes instead of nurses who don't know.
Click to expand...
Well done Dasroots - this is exactly what should be happening if you are able to self-manage

From new NICE guidelines:
1.14 Care of adults with type 1 diabetes in hospital
Blood glucose control
1.14.1 Aim for a target plasma glucose level of 5–8 mmol/litre for adults with type 1 diabetes during surgery or acute illness. [new 2015]
1.14.2 Establish a local protocol for controlling blood glucose levels in adults with type 1 diabetes during surgery or acute illness to achieve the target level. [new 2015]
1.14.3 Use intravenous in preference to subcutaneous insulin regimens for adults with type 1 diabetes if:
  • the person is unable to eat or is predicted to miss more than 1 meal or
  • an acute situation is expected to result in unpredictable blood glucose levels – for example, major surgery, highdose steroid treatment, inotrope treatment or sepsis or
  • insulin absorption is expected to be unpredictable, for example because of circulatory compromise. [new 2015]
1.14.4 Consider continuing the person’s existing basal insulin regimen (including basal rate if they are using continuous subcutaneous insulin infusion [CSII or insulin pump] therapy) together with protocoldriven insulin delivery for controlling blood glucose levels in adults with type 1 diabetes during surgery or acute illness. [new 2015]
1.14.5 Use subcutaneous insulin regimens (including rapidacting insulin before meals) if an adult with type 1 diabetes and acute illness is eating. [new 2015]
1.14.6 Enable adults with type 1 diabetes who are hospital inpatients to selfadminister subcutaneous insulin if they are willing and able and it is safe to do so. [new 2015]
Click to expand...
 
My experience several years ago on a sliding scale was similar to yours. The last time I was in hospital I refused to have one and self-administered - and ignored the advice given to not give myself my basal. In these cases we usually are the experts! Hope you feel much better now.
 
Thanks guys. I'm just refusing to give them my insulin. So I have it in my bag. The pharmacist and consultant where fine once I explained I knew what I was doing the reg was still abit funny. Your not suppose to do that in hospital. Last night was scary. I had to be really forceful to get them to turn the sliding scale off when I was hypoing. Then they wouldn't let me have any insulin with breakfast cos I was 5.3mmol. I injected in the end and was on target for lunch.

I'm out of HDU now on a respiratory ward so the care if anything is worse. Thanks for the support guys.
 
I too had to fight to keep my insulin as nurses wanted to lock it away I refused and compromised by letting them test my blood and record it but as it was 2 hours pre meal when they tested I tested again and injected what I needed,the nurses were very impressed at my tight control,sadly lost this after op and so far still stuggling
 
Thank god you stood your ground Dasroots. I've had similar experience on sliding scale to. Admitted for DKA but obviously too much insulin as going low but nurses ignoring the doctors orders to test ever 2 hours and just telling me to sleep!! I was panick stricken but luckily had my meter with me and my hubby has been in with loads of glucose and biscuits.
Hope your asthma improves tomorrow and that you can return home soon.
 
Hi. I would advise most people to refuse sliding scale other than by exception. The reasons for using it at all are unclear and most nurses wouldn't have a clue. At my last op at a private hospital they were happy for me to keep and use my own insulin and they did blood tests as well as mine when they thought relevant; worked well. I think sliding scale goes back to the early days of insulin, vials and weak control?
 
They'd have to wrestle me to the ground to take my insulin and test kit away, not a chance unless I was incapable. I had a horrid experience in the cardiology ward with a blood sugar of 1.6, I'd been conscious for 1 day, and only just diagnosed but even I knew that wasn't good. I threatened to pull the drip out I was already known as "ripper" because I ripped out 3 arterial lines when semi conscious, so I think that swung it. I waited half an hour for some juice though, surprised they didn't kill me, which would have been annoying after spending 2 weeks in HDU. It really isn't good enough. They should actively encourage self management, rather than assume they know best when clearly they don't.
 
Make your insulin regime sound complicated and they will happily let you manage your own 😉
 
LOL @khskel ! Years ago they were really good with sliding scales - in 1985 I had a hysterectomy and since I throw up unremittingly (that time, for the 5 days after my op) so I stayed on the scale and glucose drip and they kept my BG as near as dammit to 5. Brilliant. See - that's what you got with BUPA in those days but I'd had good control for 3 days on one in an ordinary NHS hospital a couple of years before that, so I wasn't scared of it.

Now, I never seem to hear anything good but the thing is, since it seems I do always do this upchucking (and normally take 24 hrs plus to even regain proper consciousness after more than a whiff of GA) unless I was almost constantly attended by a pump savvy DSN, which is most unlikely - I rather think I'd be stuck with it anyway for a while. Just EEk, if I ever need to go in for a GA again.
 
Coming from a student nurse point of view (mental health but will be doing general training to be dual qualified) I understand that nurses and doctors want to administer medication themselves to make sure it's working, make sure it's administered safely and correctly etc etc in line with government guidelines. HOWEVER if a person is on insulin and has managed perfectly fine at home, I can't understand why staff get funny about self administering. A patient knows their insulin needs better than a nurse! Insulin is different for everyone so I would actively encourage self management as long as we had a record of it for safety reasons
 
Well I am a nurse working on a surgical ward and we are generally told that insulin is to be treated like any other drug - i.e. taken away from the patient and locked away so that patients can't just self-administer without us knowing about it. Personally I don't agree with this and if a patient has diabetes and self manages their insulin at home I just let them keep it and tell them to just let me know when and how much they have injected. I think the point is that when a patient is in hospital we ( i.e. the nurses and medical staff) are responsible for their care and if anything was to go wrong we would then get the blame. Insulin also has to be prescribed by a doctor before it can be administered - also something that can be a bit tricky with MDI regimes and the dose changing according to what the patient has eaten. I have been spoken to rather sharply by my charge nurse in the past for not taking insulin away from patients but I just refuse - and there no way I would give mine over if I was a patient either!
 
Ward staff don't seem to have much idea about diabetes, it's definitely a specialist subject! When my daughter had her appendix out she was out on a sliding scale for 24 hours. It was set at one level for BG above 14, slightly lower for 7-14 and even lower for below 7. The nurses came round in pairs to double check each other when they changed anything - which is good I suppose but it amused me because nobody double checks me and I do make mistakes sometimes! They said they were having to adjust it up and down all night, which suggests that the rate should have been set somewhere in the middle; I realise that the nurses can't change anything without the say so of a doctor, but I was most relieved when they let my daughter go back on her own pump and I could take charge again. Even though that meant them waking me up in the night to deal with it if she was going high!
 
I hope you're better and home soon, Dasroots. Good for you, for fighting them off your insulin.😱🙂
 
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