Sliding scale insulin began as the primary method of treating individuals who suffered from diabetes. The term "sliding scale" refers to a progressive increase in insulin dosage that is defined by the individual's blood glucose range. The sliding scale regimen attempts to approximate, as closely as possible, the daily insulin requirements of the body.
Rapid Acting
According to the University Of California Diabetes Education Online, rapid acting or fast acting insulin is absorbed quickly from the subcutaneous tissue and enters the bloodstream, where it can be used immediately. It is used to control blood sugar during meals and snacks or to correct high blood sugar values immediately before a meal or between meals. According to LifeClinic.com, fast acting insulin includes lispro, novolog and glulisine. These should be injected within 15 minutes before an individual eats because the insulin begins working between five and 15 minutes after injection. Blood sugars will begin to decline within 45 minutes and the insulin finishes working between three and four hours after injection.
Short Acting
According to the University Of California Diabetes Education Online, regular insulin has an onset of one half hour to one hour after administration. It will peak in two to four hours after injection and will last from six to eight hours. This is the only insulin that qualifies as short-acting insulin used in sliding scale protocols. A larger dose of regular insulin will increase the onset of action but gives it a longer time to peak and a longer duration of effect.
Intermediate Acting
According to FamilyDoctor.org, intermediate acting insulin, such as NPH, begins working in 60 to 90 minutes after injection and will last up to 24 hours. Prior to 2006 this category of sliding scale insulin also included ultralente. It was taken off the market because the insulin was not dependable after administration. According to University of California Diabetes Education Online, very small doses of NPH insulin will have an earlier peak effect at a shorter duration of action. However, higher doses will have a longer time before the insulin reaches peak effect and the individual will experience a longer duration of effect of the insulin.
Long Acting
Long acting insulin is a new type of analog insulin that is used in sliding scale protocols, according to LifeClinic.com. Glargine is a long acting insulin that is injected once a day. Activity begins almost one hour after the injection but is sustained, with the relative constant rate, for approximately 24 hours. The individual will experience no peaks or valleys over that 24 hour period.
