Managing High Blood Sugar Levels: Nurse’s Guide to Sliding Scale Insulin for Type 1 Diabetes

For individuals with Type 1 diabetes mellitus, managing blood sugar levels is a daily priority. High blood sugar, or hyperglycemia, can have adverse effects on health if left unaddressed. When a client’s fingerstick glucose level at bedtime measures 258mg/dl, it’s crucial for healthcare providers, including nurses, to take action promptly. In this article, we’ll explore how nurses should respond when faced with this situation, specifically when an order for sliding scale insulin is in place.

Understanding Sliding Scale Insulin:

Sliding scale insulin is a regimen that allows healthcare providers to adjust insulin doses based on a client’s current blood sugar level. This approach provides flexibility in insulin management, particularly in response to fluctuating blood glucose levels.

The Role of the Nurse:

As a nurse, your role in managing high blood sugar levels is pivotal. Here’s a step-by-step guide on how to respond when a client with Type 1 diabetes mellitus presents with a bedtime fingerstick glucose level of 258mg/dl and a sliding scale insulin order:

  1. Assessment:

    Begin by assessing the client’s overall condition. Look for any signs or symptoms of hyperglycemia, such as excessive thirst, frequent urination, fatigue, or confusion.

  2. Confirm the Blood Sugar Level:

    Double-check the client’s bedtime fingerstick glucose level to ensure its accuracy. If the result remains high, proceed with the following steps.

  3. Review the Sliding Scale Insulin Order:

    Refer to the client’s medical chart to confirm the sliding scale insulin order. This order typically includes specific instructions on the dosage of insulin to administer based on the client’s blood sugar level.

  4. Prepare the Insulin:

    Gather the necessary supplies, including the prescribed insulin, syringe, or insulin pen. Ensure that the insulin is the correct type and concentration as indicated in the order.

  5. Calculate the Insulin Dose:

    Use the sliding scale provided in the order to calculate the appropriate insulin dose. This calculation is based on the client’s current blood sugar level (258mg/dl) and the sliding scale’s specified dosing instructions.

  6. Administer the Insulin:

    Administer the calculated insulin dose to the client via subcutaneous injection. Be sure to follow safe injection practices, such as proper site rotation and aspiration (if required).

  7. Reassess and Monitor:

    After administering insulin, closely monitor the client’s response. Assess for any signs of hypoglycemia, especially if a rapid-acting insulin was administered.

  8. Educate the Client:

    Take the opportunity to educate the client on the importance of blood sugar management, insulin administration, and lifestyle factors that can impact blood glucose levels. Encourage them to report any symptoms or concerns promptly.

  9. Document:

    Document the entire process, including the client’s initial blood sugar level, the insulin calculation, administration, and the client’s response. Accurate documentation is essential for continuity of care and future reference.


Managing high blood sugar levels in clients with Type 1 diabetes mellitus is a critical aspect of nursing care. Sliding scale insulin provides a valuable tool for addressing elevated blood glucose levels promptly and effectively. As a nurse, your ability to assess, calculate, and administer insulin accurately is vital in ensuring the client’s well-being and preventing complications associated with hyperglycemia. Additionally, patient education plays a crucial role in empowering clients to take an active role in their diabetes management and achieve better blood sugar control.


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