What is the Issue with Insulin Sliding Scales?
The use of insulin sliding scale (ISS) to manage diabetes is a common practice in hospitals as well as long term care facilities <1>. Insulin sliding scales are dosing schedules that guide insulin administrators (i.e. nurse practitioner or patient) to inject insulin based on blood glucose readings. In other words, ISS treats hyperglycaemia after it has occurred, making ISS a "reactive" approach <1>. Many studies have shown that using ISS alone to manage diabetes is an ineffective way to manage blood glucose levels<1>. In fact, traditional ISS leads to what is known as the "Roller Coaster" effect, as seen in the image to the right. Instead, guidelines and evidence advocate for a "proactive" approach to managing blood glucose levels, using basal and bolus insulin <1>. For more information on the "proactive" approach, please refer to "Insulin Sliding Scale & LTC" tab.
Image from: http://www.endotext.org/diabetes/diabetes19/diabetesframe19.htm
References:
1. Umpierrez GE, Smiley D, Zisman A. et al. Randomized study of basal-bolus insulin therapy in the inpatient management of patients with type 2 diabetes (RABBIT trial). Diabetes Care 2007;30: 2181– 2186
1. Umpierrez GE, Smiley D, Zisman A. et al. Randomized study of basal-bolus insulin therapy in the inpatient management of patients with type 2 diabetes (RABBIT trial). Diabetes Care 2007;30: 2181– 2186