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August 11, 1997

Sliding Scale Insulin Use

Author Affiliations

Lakewood, NJ

Arch Intern Med. 1997;157(15):1776. doi:10.1001/archinte.1997.00440360222036

I am writing about the article by Queale et al1 entitled "Glycemic Control and Sliding Scale Insulin Use in Medical Inpatients With Diabetes Mellitus." I concur wholeheartedly with the authors' conclusions. Their results did not surprise me, since I have always regarded the sliding scale insulin regimen as totally illogical, whether based on capillary blood glucose measurements, as used now, or on glycosuria, as used when I was a resident. Glycemia reflects, after all, occurrences in the period preceding the point of measurement, and need bear no relationship to subsequent events. If short-acting insulin is to be given, it should be at specific doses at regular intervals; if capillary blood glucose levels are too high or too low at a given point, the corresponding insulin dose should be adjusted the subsequent day. Observation of the pattern of insulin need then helps in selecting the type and the dosage of

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