AJM Theme Issue: Diabetes/Metabolism
Review
Sliding Scale Insulin Use: Myth or Insanity?

https://doi.org/10.1016/j.amjmed.2006.05.070Get rights and content

Abstract

Inpatient hyperglycemia in people with or without diabetes is associated with an increased risk of complications and mortality, a longer hospital stay, a higher admission rate to the intensive care unit, and higher hospitalization costs. Despite increasing evidence that supports intensive glycemic control in hospitalized patients, blood glucose control continues to be challenging, and sliding scale insulin coverage, a practice associated with limited therapeutic success, continues to be the most frequent insulin regimen in hospitalized patients. Sliding scale insulin has been in use for more than 80 years without much evidence to support its use as the standard of care. Several studies have revealed evidence of poor glycemic control and deleterious effects in sliding scale insulin use. To understand its wide use and acceptance, we reviewed the origin, advantages, and disadvantages of sliding scale insulin in the inpatient setting.

Section snippets

The Origin of Sliding Scale Insulin

Following the discovery of insulin by Banting and Best in 1921, regular insulin was the only insulin formulation available, and it was not until 1937 that the first modified insulin was introduced. Multiple injections given 2 to 4 times daily was the insulin regimen recommended for most patients.21 Since the early days it became evident that the administration of pancreatic extracts decreased blood glucose levels in a dose-dependent fashion, but insulin overtreatment could result in significant

Advantages and Disadvantages of Sliding Scale Insulin

Potential advantages of the sliding scale insulin are convenience, simplicity, and promptness of treatment initiation. The sliding scale ensures that insulin therapy will be given when hyperglycemia is first recognized. The regimen is easily implemented in general surgical and medicine areas, and does not depend on locating the attending physician or housestaff concerning the necessary insulin dosage. The use of regular insulin per sliding scale, however, as a single insulin regimen in

Myth or Insanity?

The use of sliding scale insulin could be considered a medical myth. Medical myths are concepts we are taught that are just plain wrong. Myths are usually easy to remember and thus are passed from generation to generation without evidence to support their use.40 Although it has long been recognized that sliding scale insulin has many drawbacks, its use in the inpatient setting has been a reflex action passed down from attending physicians to residents to medical students despite a lack of

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