From the Guidelines
The use of a sliding scale insulin regimen is not recommended as a standalone treatment for hospitalized patients with diabetes, and instead, a basal-bolus insulin regimen should be used to achieve better glycemic control and reduce the risk of hypoglycemia and other complications 1. When considering the administration of regular (short-acting) insulin, it's essential to prioritize a basal-bolus insulin regimen, which includes the administration of basal insulin given once or twice daily along with rapid-acting insulin given before meals, plus corrective doses of rapid-acting insulin.
- For insulin-naive patients or those treated with low doses of insulin, a total daily insulin dose between 0.3 and 0.5 U/kg is recommended, with half of the total daily insulin dose allocated to basal insulin dosing (1–2 times daily) and the other half to rapid-acting insulin (divided three times daily before meals) 1.
- A sliding scale insulin regimen may be used as a supplement to a basal-bolus insulin regimen, but it should not be used as the primary method of insulin administration. Some key points to consider when using a sliding scale insulin regimen include:
- Administering 0 units for blood glucose below 150 mg/dL, 2 units for 150-200 mg/dL, 4 units for 201-250 mg/dL, 6 units for 251-300 mg/dL, 8 units for 301-350 mg/dL, and 10 units for readings above 350 mg/dL 1.
- Always checking blood glucose before meals and at bedtime.
- Personalizing the sliding scale based on individual insulin sensitivity, weight, and overall health status, and adjusting it regularly with healthcare provider guidance to prevent both hyperglycemia and hypoglycemia 1. It's also important to note that the use of sliding scale insulin regimens has been associated with clinically significant hyperglycemia in many patients and its use has been discouraged in favor of a basal-bolus approach 1. Regular insulin (also called short-acting insulin) is different from rapid-acting insulins like lispro or aspart, which have faster onset times. The sliding scale should be adjusted regularly with healthcare provider guidance to prevent both hyperglycemia and hypoglycemia 1.
From the Research
Sliding Scale Protocol for Administering Regular Insulin
- The sliding scale protocol for administering regular (short-acting) insulin is not recommended by several studies 2, 3, 4 due to its ineffectiveness and potential dangers.
- Instead, basal-bolus insulin therapy or continuous intravenous insulin infusions are preferred for managing hyperglycemia in hospitalized patients 2, 3.
- The use of sliding-scale insulin has been associated with an increased incidence of hyperglycemic events and does not provide any benefits in blood glucose control 4.
- Short-acting insulin analogues are superior to regular human insulin in reducing hypoglycemia and postprandial glucose levels in patients with type 1 diabetes mellitus 5.
Alternative Insulin Regimens
- Basal-bolus insulin therapy usually involves a single daily dose of insulin glargine at bedtime and bolus injections of a rapid-acting insulin shortly before or after meals 2.
- Continuous intravenous insulin therapy is preferred for critically ill patients, while scheduled subcutaneous basal-bolus insulin regimens are suitable for non-critically ill patients 3.
- Modern insulin analogs, such as long-acting basal insulin analogs and rapid-acting insulin analogs, offer advantages over older human insulins in terms of their time-action profiles and lower propensity for inducing hypoglycemia 3.