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SLIDING SCALE INSULIN AND GLYCEMIC CONTROL IN THE HOSPITAL.

Diabetic patients are frequently converted from oral agents or long-acting insulin to short-acting sliding-scale insulin regimens when they are hospitalized. This study examined the logic of that practice.

Researchers prospectively observed 171 diabetic adults hospitalized for nonsurgical conditions (usually cardiovascular disease or infection). Thirty-seven percent received sliding-scale short-acting insulin four times daily with no standing oral agent or intermediate-acting insulin. The remainder had standing orders for an oral agent or intermediate-acting insulin with or without a superimposed sliding scale. A typical sliding-scale regimen was two units of regular insulin for a blood glucose above 150 to 200 mg/dl, with 2-unit increments for each 50-mg increment in blood glucose.

On a multivariate analysis adjusting for severity of illness and other characteristics, patients on sliding-scale regimens alone were significantly more likely to have hyperglycemic episodes (i.e., blood glucose over 300 mg/dl) than those on standing longer-acting regimens. There was no association between diabetes regimen and hypoglycemia.

Comment: While unknown confounding factors could have biased this study, the findings suggest that sliding-scale insulin regimens are not optimal when used alone for acutely ill inpatients. An editorialist believes that we should avoid this common practice.

— AS Brett

Published in Journal Watch General Medicine April 4, 1997

Citation(s):

Queale WS et al. Glycemic control and sliding scale insulin use in medical inpatients with diabetes mellitus. Arch Intern Med 1997 Mar 10 157 545-552.

• Medline abstract (Free)

Sawin CT. Action without benefit: The sliding scale of insulin use. Arch Intern Med 1997 Mar 10 157 489-489.

• Medline abstract (Free)