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Editor's Correspondence
July 13, 1998

Sliding Scale Fallacy

Author Affiliations

Copyright 1998 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.1998

Arch Intern Med. 1998;158(13):1469-1472. doi:

During my training in Holland, I never encountered the so-called sliding scale for insulin used to treat patients with diabetes. When first confronted with this regimen here in the United States, I failed to grasp how it benefited the patient; consequently, I never used it.

With due respect to my colleagues, I believe that the sliding scale, which hardly benefits the patient, was invented by a "take-it-easy" mind. On first impression, one might think that physicians who write sliding scale orders are alert, aware of, and concerned with their patient's blood glucose levels. In fact, physicians are hardly involved in this process anymore; rather, it is the nurse who watches the patient's glucose level and acts according to the physician's written orders. Without the sliding scale regimen, physicians would be obligated to find out from their patients why their blood glucose levels had risen.

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