Fixed dose insulin therapy may be used with these common regimens:

• Long-acting insulin (glargine/detemir/degludec or NPH), once or twice a day with short acting insulin (aspart, glulisine, lispro, regular) before meals and at bedtime
• Long-acting insulin (glargine/detemir/degludec or NPH), given once a day
• Regular and NPH, given twice a day
• Pre-mixed, or short-acting insulin analogs or Regular and NPH, given twice a day

The general principles of sliding scale therapy are:

• The amount of carbohydrate to be eaten at each meal must be consistent.
• The basal (background) insulin dose doesn’t change. You take the same long-acting insulin dose no matter what the blood glucose level.
• The bolus insulin is based on the blood glucose level before the meal or at bedtime.
• Pre-mixed insulin doses are based on the blood glucose level before the meal, and assumes you are eating a "set amount" of carbohydrates.

Disadvantages of the sliding scale regimen:

• The sliding scale method does not accommodate changes in insulin needs related to variable snacks or to stress and activity.
• You still need to identify and estimate carbohydrates.
• Sliding scales are less effective in covering a pre-meal high blood glucose, because the high blood glucose correction and food bolus cannot be split.

Points To Remember!

The sliding scale can be used in many ways.  One method assumes that the carbohydrates eaten for every meal is the same. 

• When using a sliding scale, eat the same amount of carbohydrate at each meal. In other words, while the foods may change, the time and the carbohydrate content of the meal should not vary.
• Eat the pre-assigned amount of carbohydrate for each meal, and at a similar time of the day.
• The sliding scale method may seem easier, because there are fewer calculations. However, to be successful, it requires a strict adherence to a consistent schedule of meals and activity, and following your prescribed diet.

Sliding scale regimens may include a bedtime high blood glucose correction. As the nighttime scale only considers the amount of insulin required to drop your blood glucose level back into the target range, it should not be used to cover a bedtime snack.

• Engage in an equivalent level of activity from day to day. Try not to vary the timing, type or duration of activity.

FOR SUCCESSFUL SLIDING SCALE THERAPY YOU NEED A CONSISTENT & PREDICTIBLE LIFESTYLE.

There are many variations to these regimens. Check with your provider and Diabetes team to determine which one is best for you.