 hello guys today we are talking about how to bring your blood sugar down with insulin now we have other videos about how to bring the blood sugar down fast etc but we did not talk about in detail about how to use the sliding scale we kind of briefly mentioned it of course there are other ways to bring the blood sugar down you don't have to take insulin always but in some cases you feel like you have to because no matter what you do it's not coming down then we use the insulin by the way I'm Dr. Ahmed Ergin I'm an endocrinologist at Dobby's education specialist Dobby is pretty much my life so I'll tell you what I'm doing in my practice by no means this is not a medical advice this is just to give you an idea of what I do in my practice so you have an idea as well and make sure you discuss with your doctor as well before you do anything as well all right so let's get started guys so summarize today we are going to talk about is sliding scale insulins and how to bring the blood sugar down I also make sure that you watch the entire video because this is a technical video if you do something wrong you may hurt yourself and I as I said always run it by your doctor but jumping to the conclusion and not watching the entire video may give you the wrong impression okay so remember we are using short-acting insulins here to correct your blood sugars never long-acting or intermediate acting insulins short-acting insulins are Novalog, Himalog, Epidra, Phaea, Spodmalog, whatever you have it in your hands these are the short-acting insulins even the regular insulin sometimes like Novelin R, Himalon R will work that slower not as fast but they're still considered a rapid-acting insulin but definitely not your long-acting insulin such as Tujail, Lontos, Terceba, Barsglar etc. all right so what I did here I also put the numbers in European measurements millimoles in red here in this table created table for you guys a sliding scale table some of you are familiar with it and then these black ones are milligram per deciliter which is the American measurement so guys don't jump to the screen don't try to copy right away because I will tell you a few tricks about how to really use this table effectively because it looks a lot of numbers looks like more south of it here so just just stay put here for a second so basically of course these are your numbers right so you're gonna refer to this table or something similar to this table with your doctor's approval but the way it works is how much insulin you are going to take based on your number depends on how much you're currently taking this number one and depends on your insulin resistance as well so for example a patient with type 1 diabetes for example or or a very insulin sensitive type 2 or some type 3 diabetics are actually insulin sensitive because of a variety of reasons that I'm not gonna go into detail right now but they have to take insulin for one or the other reason but type 1s typically are very insulin sensitive most type 1s not all type 1s but for them if they are taking for example anywhere between 1 and 5 p units for their meals typically that's insulin sensitive because consider it because it's really not a lot of insulin you know taking three units for a meal is really not a lot right so for them if their blood sugar is let's say 175 and they fall in here 150 to 200 or let's say their blood sugar is in this case something around 9.5 or something in European measurement millimole then they can take another one unit if their blood sugar is in that range that will safely bring them down to a more reasonable rate so if they are not eating for example let's say I'm type 1 and it's lunch time but my blood sugar is 190 and I don't like that number but I'm not gonna eat now normally I take around three to four units for my meals and I don't like this 190 number or in this case let's say 10.8 number then what I would do is I would take one unit of insulin just to bring the blood sugar down around 50 points so that one unit will bring you down 50 points that's why these measurements are the sliding scale is in 50 unit increments the numbers you see here are designed on the red are designed to bring your blood sugar down by 50 points 50 milligram per this liter but that's what it is okay so you're taking one unit for example for that now let's say I am a person who takes not less than 5 units but less than 10 units let's say I take normally 8 units for my meals okay now in that case I refer to my second sliding scale of which call it sliding scale number 2 so in this case instead of let's say the same person same type 1 or could be type 2 in this case a little bit more insulin but my blood sugar is 190 and I take normally 8 units which is between 5 and 10 units okay anywhere from between 5 and 10 units for my typical meals as of what I take that's what my insulin resistance like for those patients I tell them to take 2 units to bring the blood sugar down 50 points so in this case if my blood sugar is 190 if I take 2 units I expect my blood sugar to come down to 140 without eating now of course if I'm eating I can still take my meal time insulin which is if the doctor said hey take 8 units for every meal and I if I'm eating and my blood sugar is still high then I can still take that 8 units plus I can take extra 2 units because my blood sugar is high if my blood sugar was like 100 I would still take my 8 units for my meal because if you don't take that then your blood sugar spiked so this is one of the number one reason why people's blood sugar go high is because they're scared of insulin their blood sugar is in the normal range and they think that they don't eat insulin well how about the carbs you're eating in your meal or even protein can even increase your blood sugar what is it gonna do your blood sugar will go up so it's not uncommon for people to come and say doc my blood sugar goes up anyways no matter what I do and basically what they do is if their blood sugar is 90 and they go eat a half a chicken and salad and they think that that's gonna be okay that's not gonna do anything well if you eat a lot of chicken a lot of salad that can still increase your blood sugar if you don't take any insulin at all especially if you're insulin resistant for people who do not take a regular insulin for their meal time okay for them I will tell you how to come up with these numbers because right now I'm talking about how to come up with these correction numbers correction insulin based on what you're taking for the meal time all right so same thing for the three units if I'm taking a lot we talked about taking between one and five units per meal then you probably need one unit to correct your blood sugar bar for by 50 points if you're taking normally between five and ten units per meal then you will need probably two units to correct your blood sugar 50 points if you are taking anywhere from 10 to 15 units per meal then you'll probably need three units to bring your blood sugar down 50 points now what I did here we're talking about the first one the between 150 and 200 but if your blood sugar is higher let's say 200 250 or between 250 250 and 300 then as you can see these numbers are going up typically they are you know going up in increments let's say for a sliding scale number one for somebody who's taking less than five units of insulin per meal every every 50 points they're increasing their insulin one two three for somebody who take you know five to ten years of insulin they take two units if they're in roughly and 200 they take 40 units if they are between 250 250 so basically what you're doing you're doubling right so you are if I'm supposed to take two units to bring my blood sugar down 50 points then if I want to bring my blood sugar down 100 points then I will take four simple as that it's a simple math okay I did this here just to give a little more ease but this is your baseline numbers and then once you know how much insulin to take to blood sugar to bring your blood sugar down by 50 points then you can just make the math and say hey you know my blood sugar is right now 230 I want it to be 130 I have an excess of 100 and I normally take two years to bring my blood sugar down 50 points then in this case I will need 40 units to bring my blood sugar down 100 points it's just a little math that you need to get used to to be more precise in your in your decisions same thing if somebody is taking between you said five one to five five to ten 10 to 15 15 to 20 units of insulin if you're taking 15 to 20 units of insulin per meal you will need around 40 units of insulin to bring your blood sugar down by 50 points if you are taking between 15 to 20 I'm sorry this is about 5 10 15 20 if you're taking 20 to 25 years of insulin per meal then you will need five units to bring your blood sugar down by 50 points now let's talk about how to bring your blood sugar down if you're not taking insulin at all for your meals your blood sugar is still high how do you come up with these numbers alright so basically that is going to change depending on your weight so now here I'm gonna use kilograms because there's more universal measurement so the American watchers in this case will have to turn their pounds into kilograms okay but it's not that difficult really like one kilogram is 2.2 pounds so you just divide it by 2.2 then you have your kilograms if you are using pounds so but basically I think it is safe to say that if you are 100 kilograms let's say 100 kilograms okay now most people will need a total daily insulin you know let's then 0.5 units per kilo so in this case somebody with 100 if they take 50 units total total insulin if they were supposed to take insulin that would be their kind of average insulin they of course they may need more or less but that's kind of a typical average diabetic takes when they are an insulin around you know 0.5 units per some people take up to one unit per kilogram but as I said 0.5 is a good starting point so you can always adjust that as well depending on your response so that means that you need around 50 units if you're 100 kilograms now we have something called 1800 rule right so 1800 rules tells you what is your insulin to take to bring your blood sugar down by 50 points okay so in this case let's do the math quick here if you divide with 1800 by 50 that's gonna give you around 36 so you can round that up to 40 so that means that if you are 100 kilogram person one unit of insulin of hemologue or novel log will bring you down around 40 points okay so the 50 rule typically applies with the sliding scale but if you are not taking a mealtime insulin in this case you need to find how much of one unit of short acting insulin bring your blood sugar down and then that's your ratio now you may not be comfortable with that so I'm gonna let your doctor to decide on this I'm gonna give you a quick trick here if you're gonna need one unit to bring your blood sugar down 40 points you can think that you can start with this because the one unit that brings you down on this scale 50 points so if that doesn't work you're anywhere between one and two units to bring the blood sugar down 50 points so you can try the one unit to bring down 50 and if it didn't work enough then you can always try the two units to bring it blood sugar down by 50 points and see how that works and you can choose your sliding scale as I said these are also number of sliding scale you know some people as we talked about needs as little as one unit to bring the blood sugar down and some people will need as much as five units to bring the blood sugar down so remember guys though it is what we are talking about here is a short acting insulin so do not use the scale with long acting insulin never long acting insulins that's why we call them long acting insulin they are not going to bring your blood sugar down fast you have to use a short acting insulin such as another log hemologue a pedra fiasp adenologue whatever you have it but those are the short acting insulin sometimes even regular insulin will work but not the long acting insulins I hope that helps you guys and if it does please give a thumbs up and share this video with family and friends we'll see you later