Sliding-Scale Insulin
More evidence needed before final exit?
- Abbas E. Kitabchi, PHD, MD and
- Ebenezer Nyenwe, MD
- From the Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
- Address correspondence to Abbas E. Kitabchi, PhD, MD, Division of Endocrinology, Department of Medicine, University of Tennessee, Health Science Center, 956 Court Ave., Suite D334, Memphis, TN 38163. E-mail: akitabchi{at}utmem.edu
Sliding-scale regular insulin (SSI) in the management of patients with diabetes was the standard practice as early as 1934 (1) and was also used in the hyperglycemic emergency diabetic ketoacidosis (2). These earlier studies used urine glucose for sliding scale, but with demonstration of inaccuracy of urine glucose (3), blood glucose replaced urine glucose for sliding scale in diabetic ketoacidosis (4). SSI is widely used in health institutions (5,6) because it is easy and convenient, but it has the disadvantage of not delivering insulin in a physiologic manner, thereby leading to fluctuations in glycemic levels (7–9). Despite these drawbacks, the use of SSI has survived for >70 years, through many generations of physicians. Retrospective (6,9) and prospective (5) cohort studies, as well as observations and commentaries (10), have concluded that SSI should be discouraged because it has not been shown to be an effective means of achieving much-needed optimal glycemic control in hospitalized patients.
However, the issue of SSI has never been settled because of the …
