From the Guidelines
To come up with an effective insulin regimen, a basal-bolus approach is recommended over a sliding scale insulin regimen, as it provides better glycemic control and reduces the risk of complications, according to the most recent and highest quality study 1. When determining the insulin regimen, it's essential to consider the patient's individual insulin sensitivity, weight, and medical conditions.
- A basal-bolus approach 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.
- The total daily insulin dose should be between 0.3 and 0.5 U/kg, with half allocated to basal insulin dosing and the other half to rapid-acting insulin.
- For patients treated with higher doses of insulin at home (≥0.6 U/kg per day), a 20% reduction in the total daily insulin dose is recommended while they are in hospital to prevent hypoglycaemia.
- A basal-plus approach, consisting of a single dose of basal insulin along with corrective doses of insulin, may be preferred for patients with mild hyperglycaemia, those with decreased oral intake, and for patients undergoing surgery. The use of sliding scale insulin alone is discouraged, as it is associated with clinically significant hyperglycaemia and does not provide favorable in-hospital outcomes, as stated in 1 and 1. Instead, a basal-bolus approach or a basal-plus approach should be used, as they have been shown to provide better glycemic control and reduce the risk of complications, as seen in 1. It's crucial to monitor the effectiveness of the regimen by checking post-meal glucose levels 2 hours after eating and adjust the scale as needed, taking into account the patient's individual response to insulin, meal content, and activity levels.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Developing a Sliding Scale Insulin Regimen
To create a sliding scale insulin regimen, several factors must be considered, including the patient's current medication, glucose levels, and risk of hypoglycemia.
- Medication Considerations: When adding insulin to a patient's regimen, it is essential to consider the medications they are already taking. For example, studies have shown that adding insulin to metformin can be beneficial for glycemic control, but may increase the risk of hypoglycemia compared to adding a sulfonylurea 2, 3.
- Glucose Level Monitoring: Regular monitoring of glucose levels is crucial in developing a sliding scale insulin regimen. This allows for adjustments to be made based on the patient's glucose levels, reducing the risk of hypoglycemia 4, 5.
- Risk of Hypoglycemia: The risk of hypoglycemia must be carefully considered when developing a sliding scale insulin regimen. Certain medications, such as sulfonylureas, can increase the risk of hypoglycemia, especially in patients with renal impairment 5.
- Treatment Outcomes: Studies have shown that adding insulin glargine to metformin can provide efficacy and safety benefits, especially when initiated early in treatment 6.
Key Considerations
When developing a sliding scale insulin regimen, the following key considerations should be taken into account:
- The patient's current medication regimen and how it may interact with insulin
- The patient's glucose levels and how they may fluctuate throughout the day
- The risk of hypoglycemia and how to minimize it
- The patient's individual needs and treatment goals
Factors Influencing Sliding Scale Insulin Regimen
Several factors can influence the development of a sliding scale insulin regimen, including:
- Renal Function: Renal impairment can increase the risk of hypoglycemia, especially when using sulfonylureas 5
- Medication Dose: The dose of medication, especially sulfonylureas, can impact the risk of hypoglycemia 5
- Treatment Duration: The duration of treatment can impact the risk of hypoglycemia and the effectiveness of the sliding scale insulin regimen 4