Hi all. I'm a relatively new inpatient pharmacist and I've run into this situation twice that has made me pretty uncomfortable. I have seen two orders for type 2 diabetic patients on Novolog 70/30 TIDAC with sliding scale parameters, including parameters for giving insulin when BG <120. For example:
| BG | Breakfast | Lunch | Dinner |
|---|---|---|---|
| <60 | 20 | 10 | |
| 61-80 | 25 | 15 | |
| 81-120 | 30 | 20 | |
| 121-180 | 35 | 25 | |
| 181-240 | 40 | 30 | |
| 241-300 | 45 | 5 | 35 |
| 301-400 | 48 | 8 | 40 |
| >400 | 50 | 10 | 45 |
(not an actual patient's SS, but similar to what I've seen)
From what I remember learning in school, patients are typically on 70/30 BID based on the peak and duration of action. I have never seen anyone give insulin when by definition they are hypoglycemic, but in one instance the patient had his office summary from his endocrinologist that matched what was ordered. I tried looking into studies with sliding scales with different insulins but wasn't able to come up with much. Is anyone able to weigh in on this?
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