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Sliding Scale Insulin—Time to Stop Sliding
Irl B. Hirsch, MD
JAMA. 2009;301(2):213-214.
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In most teaching hospitals in the United States, primary care first-year residents and medical students learn about sliding scale insulin (SSI), usually from a senior resident. The more experienced resident explains how to prescribe regular insulin every 4 to 6 hours without any scheduled basal or mealtime (prandial) insulin. For the typical patient who is too sick to eat, this results in a roller coaster effect on blood glucose variability due to poor matching of insulin with individual blood glucose patterns. Unfortunately, for the patient who is able to eat, insulin scheduled to be administered based on a bedside capillary glucose measurement is actually administered long after the meal is consumed. Although there are often challenges with hospital logistics in terms of timing of insulin administration in relation to actual food intake, the SSI orders typically do not mention the relationship of the insulin injection as . . . [Full Text of this Article]
Author Affiliation: Diabetes Care Center, School of Medicine, University of Washington, Seattle.
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