A client with type 1 diabetes mellitus has a fingerstick glucose level of 258mg/dl at bedtime. An order for sliding scale insulin exists. The nurse should:
A. Call the physician
B. Encourage the intake of fluids
C. Administer the insulin as ordered
D. Give the client 1/2 c. of orange juice
Correct Answer: C. Administer the insulin as ordered
A value of 258 mg/dl is above the expected range of 70-105 mg/dl; the nurse should administer the insulin as ordered. Sliding scale regimens may include a bedtime high blood sugar correction. As the nighttime scale only considers the amount of insulin required to drop the blood sugar level back into the target range, it should not be used to cover a bedtime snack.
Option A: It is unnecessary to call the physician. The term “sliding scale” refers to the progressive increase in the pre-meal or nighttime insulin dose, based on predefined blood glucose ranges. Sliding scale insulin regimens approximate daily insulin requirements.
Option B: When using a sliding scale, eat the same amount of carbohydrates 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.
Option D: The sliding scale method does not accommodate changes in insulin needs related to snacks or to stress and activity. The sliding scale method may seem easier because there are fewer calculations. However, to be successful, it requires strict adherence to a consistent schedule of meals and activity and following the prescribed diet.
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