A 55-year-old client newly on a sliding-scale insulin (lispr… | MyMerci
Medical EmergenciesPA
Question
A 55-year-old client newly on a sliding-scale insulin (lispro) regimen before meals asks the nurse what to do at each measurement. Which response is correct?
1Inject lispro 30 minutes before the meal, then wait until 2 hours after eating to measure blood glucose.
2Skip the dose if blood glucose is greater than 200 mg/dL because the body is already producing too much sugar.
3Check capillary blood glucose immediately before each meal, give the lispro dose specified for that glucose range on the sliding scale, eat the meal within about 15 minutes of injection, document the reading and dose, and report blood glucose less than 70 mg/dL or greater than 400 mg/dL to the provider.✓ Correct answer
4Take the same fixed dose every meal regardless of blood glucose.
Explanation
Sliding-scale insulin — correct technique Sliding-scale insulin (SSI) is a reactive regimen — the dose depends on the current capillary blood glucose. Standard process: (1) Check fingerstick blood glucose immediately before the meal (or per institution). (2) Look up the dose on the sliding scale for that glucose range. (3) Administer the rapid-acting insulin (lispro/aspart/glulisine) and eat the meal within ~15 minutes (rapid onset 5-15 min, peak 30-90 min). With regular insulin, inject 30 minutes before the meal. (4) Document the BG reading, dose, and time. (5) Report extremes: BG 400 mg/dL (or per institutional thresholds) to the provider for additional intervention (correction insulin, fluids, work-up). (6) Watch for hypoglycemia post-meal during the rapid-acting peak.
Sliding-scale alone is generally outdated as primary management for sustained hyperglycemia (basal-bolus is preferred), but it is still common as a correction-dose addition or for short hospital stays.
Other options: fixed dose ignores glucose value; skipping dose at high BG worsens hyperglycemia; lispro injects with the meal (not 30 min before — that is regular).
In-depth explanation
Clinical reasoning summary Sliding-scale insulin — correct technique Sliding-scale insulin (SSI) is a reactive regimen — the dose depends on the current capillary blood glucose. Standard process: (1) Check fingerstick blood glucose immediately before the meal (or per institution). (2) Look up the dose on the sliding scale for that glucose range. (3) Administer the rapid-acting insulin (lispro/aspart/glulisine) and eat the meal within ~15 minutes (rapid onset 5-15 min, peak 30-90 min). With regular insulin, inject 30 minutes before the meal. (4) Document the BG reading, dose, and time. (5) Report extremes: BG 400 mg/dL (or per institutional thresholds) to the provider for additional intervention (correction insulin, fluids, work-up). (6) Watch for hypoglycemia post-meal during the rapid-acting peak.
Sliding-scale alone is generally outdated as primary management for sustained hyperglycemia (basal-bolus is preferred), but it is still common as a correction-dose addition or for short hospital stays.
Other options: fixed dose ignores glucose value; skipping dose at high BG worsens hyperglycemia; lispro injects with the meal (not 30 min before — that is regular).