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
Radack HB. Sliding Scale Insulin Use. Arch Intern Med. 1997;157(15):1776. doi:10.1001/archinte.1997.00440360222036
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