From the Guidelines
A moderate insulin sliding scale is not recommended as a standalone treatment for hospitalized patients, and instead, a basal-bolus insulin regimen or a basal-plus-correction insulin regimen is preferred, as it provides better glycemic control and reduces the risk of hypoglycemia, as supported by the 2017 U.S. Department of Veterans Affairs/U.S. Department of Defense clinical practice guideline 1.
Key Considerations
- The use of sliding-scale insulin regimens is discouraged due to their lack of favorable in-hospital outcomes and increased risk of hypoglycemia 1.
- A basal-bolus insulin regimen, which includes basal insulin and short-acting mealtime insulin, or a basal-plus-correction insulin regimen, is recommended for hospitalized patients who are not in the intensive care unit 1.
- The choice of insulin regimen should take into account the patient's prehospital diabetes treatment, in-hospital dietary intake, and factors that can affect insulin resistance, such as corticosteroids or renal or liver failure 1.
Insulin Regimens
- Basal-bolus insulin regimen: provides basal insulin and short-acting mealtime insulin to cover food intake and correction doses for glucose elevations 1.
- Basal-plus-correction insulin regimen: provides basal insulin and correction doses for glucose elevations, and is suitable for patients with poor oral intake or those who are receiving nothing by mouth 1.
Monitoring and Adjustments
- Blood glucose levels should be monitored regularly, and the insulin regimen should be adjusted based on individual response and clinical situation 1.
- Patients should be monitored for signs of low blood sugar, and the insulin regimen should be adjusted to minimize the risk of hypoglycemia 1.
From the Research
Definition of Moderate Insulin Sliding Scale
- A moderate insulin sliding scale is not explicitly defined in the provided studies, but it can be inferred that it refers to a treatment approach that uses a balanced and adjustable insulin regimen to manage blood glucose levels.
- The concept of a sliding scale insulin regimen is discussed in several studies, including 2, 3, and 4, which highlight its use in hospitalized patients and its potential limitations.
Key Characteristics of Insulin Sliding Scale Regimens
- Insulin sliding scale regimens typically involve adjusting insulin doses based on blood glucose levels, often using a predefined scale or algorithm 2, 3.
- These regimens can be used in various settings, including hospitals and long-term care facilities, to manage hyperglycemia in patients with diabetes 4, 5.
- The use of sliding scale insulin regimens has been debated, with some studies suggesting that they may not provide optimal blood glucose control and may be associated with increased risks of hypoglycemia and other adverse events 2, 3.
Comparison with Other Insulin Regimens
- Study 6 compares the use of a mealtime 50/50 basal + prandial insulin analogue mixture with a basal insulin analogue, both plus metformin, in patients with type 2 diabetes.
- The results suggest that the mealtime insulin mixture may provide better glycemic control and lower rates of hypoglycemia compared to the basal insulin analogue regimen.
- However, the study does not specifically address the concept of a moderate insulin sliding scale, and more research is needed to determine the optimal insulin regimen for different patient populations.