Barriers to Change
The following list are possible reasons why insulin sliding scales continues to be commonly prescribed today despite lack of evidence.
For more information on barriers to change, please consider reading the following article:
Umpierrez GE, Palacio A, Smiley D. Sliding scale insulin use: myth or insanity? Am J Med 2007; 120: 563– 5672.
- Tradition/ Historial Practice <1>
- Fear of hypoglycaemia <1>
- Unaware of problem associated with insulin sliding scales<2>
- Unwilling to make changes to therapies initiated by another physician
- Lack of guidelines to manage diabetes LTC setting <3>
For more information on barriers to change, please consider reading the following article:
Umpierrez GE, Palacio A, Smiley D. Sliding scale insulin use: myth or insanity? Am J Med 2007; 120: 563– 5672.
Role of the Pharmacist
The following are some ways that pharmacists can assist in the process of eliminating insulins sliding scales, and better manage diabetes in long-term care.
Please refer to "Resource/Tools" tab to view resources and tools that can help you perform these roles.
- Discuss the issues surrounding insulin sliding scales with the prescribers and recommend discontinuing insulin sliding scales (and starting basal-bolus insulin regimen)
- Provide in-services to nurses, residents, and their family members on the identification and treatment of hyper- and hypoglcemia
- Discuss the issues surrounding insulin sliding scales with LTC faciltiy's Director of Care and help develop and implement protocols to initiate basal-bolus insulin regimen and ban insulin sliding scales
Please refer to "Resource/Tools" tab to view resources and tools that can help you perform these roles.
References:
1.Umpierrez GE, Palacio A, Smiley D. Sliding scale insulin use: myth or insanity? Am J Med 2007; 120: 563– 5672.
2.Roberts GW, Agullar-Loza N, Burt MG, et al. Basa-bolus versus sliding-scale insulin for inpatient glcaemic control: a clinical practice comparison.Med J Aust 2012;196(4):266-9.3.Clement M, Leung F.Diabetes and the frail elderly in long term care.Can J Diabetes 2009.33(2):114-121
1.Umpierrez GE, Palacio A, Smiley D. Sliding scale insulin use: myth or insanity? Am J Med 2007; 120: 563– 5672.
2.Roberts GW, Agullar-Loza N, Burt MG, et al. Basa-bolus versus sliding-scale insulin for inpatient glcaemic control: a clinical practice comparison.Med J Aust 2012;196(4):266-9.3.Clement M, Leung F.Diabetes and the frail elderly in long term care.Can J Diabetes 2009.33(2):114-121