From a nurse in San Diego, California, USA:
Why it is hard to get the sliding scale of a child compare to an adult? Is it because of growth pattern, or maturity of pancreatic enzyme or any other reason?
You are right in saying that published sliding scales do not generally apply to children. The reason for this is that this age group can be very volatile in terms of their response to factors like stress, recent exercise, appetite and so on.
If possible, it seems to be better to modify a meal time insulin dose in terms of both the premeal blood sugar and the number of carbs likely to be consumed.
Additional comments from Dr. David Schwartz:As I have indicated in this forum previously, while I am not a strong proponent of "sliding scales" in general, they do have their place. However, remember that a sliding scale chases and reacts to high glucose; it does not really prevent the glucose from getting that high. There is no single sliding scale. They are derived for the individual with diabetes.
A sliding scale that I have used is based on the child's weight, with smaller children getting a proportionally lower dose that larger children. This should work with adults also, but adults tend to have other factors that may make them more insulin resistant. So, one would adjust the sliding scale upward if the doses seem inadequate. This does not negate the need to follow a meal plan, exercise, take other prescribed medications, etc., to try to prevent the higher glucose levels.
Additional comments from Dr. Stuart Brink:It isn't hard to set up a sliding scale for anyone. We do it all the time and have been doing it for more than 20 years! However, kids are growing and so their sliding scales (what we call algorithms at our center) need to be adjusted more frequently than in adults.
Original posting 19 Dec 2001
Posted to Insulin
Last Updated: Tuesday April 06, 2010 15:09:28
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