Sliding Scale Therapy

flour on scale, bread

Sliding scale therapy approximates daily insulin requirements.

The term "sliding scale" refers to the progressive increase in pre-meal or nighttime insulin doses.

The term “sliding scale” refers to the progressive increase in the pre-meal or nighttime insulin dose, based on pre-defined blood glucose ranges. Sliding scale insulin regimens approximate daily insulin requirements.

Common sliding scale regimens:

  • Long-acting insulin (glargine/detemir 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 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 is pre-set.
  • 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 sugar level before the meal or at bedtime
  • Pre-mixed insulin doses are based on the blood sugar level before the meal

Sliding Scale Insulin Regimens for Type 2 Diabetes Using Multiple Daily Injections

Insulin Regimens for Type 2 Diabetes Using One Daily Injection of Insulin

Sliding Scale Insulin Regimens for Type 2 Diabetes - Pre-mixed or Split Mixed Regimens

Disadvantages of the sliding scale regimen:

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

Points To Remember!

  • Sliding scale regimens may include a bedtime high blood sugar correction. As the nighttime scale only considers the amount of insulin required to drop your blood sugar level back into the target range, it should not be used to cover a bedtime snack.
  • 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.
  • Engage in an equivalent level of activity from day to day. Try not to vary the timing, type or duration of activity.
  • 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.
  • Eat the pre-assigned amount of carbohydrate for each meal, and at a similar time of the day.


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

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