Test Your Knowledge Issue 474 Answer

Answer and Critique (Correct Answer = A)

Sliding-scale insulin is often used in hospitals but its use has not been substantiated by clinical evidence. It is a reactive rather than proactive approach to managing blood glucose and does not provide basal insulin. Patients may be at risk for prolonged hyperglycemia due to high thresholds for treatment.

The use of sliding-scale insulin has been in question for years.(23)  Discontinuation of this practice is recommended.[8,12] However, if sliding-scale insulin is ordered, precautions should be put into place. Sliding-scale insulin should only be ordered on a preprinted order or computerized order set created and approved by the organization.[8) Long-acting insulin should not be used in a sliding-scale[12] and scheduled insulin should be ordered in patients receiving a sliding-scale.[11]

23.    ning LA, Dumo P. Sliding-scale insulin: an antiquated approach to glycemic control in hospitalized patients. Am J Health-Syst Pharm. 2004;61:1611-1614.

8.    hen MR, Smetzer JL, Tuohy NR, Kilo CM. High-alert medications: safeguarding against errors. In: Cohen MR, ed. Medication Errors. 2nd ed. Washington, DC: American Pharmacists Association;2007.

9.    n LF, Bethel MA, Feinglos MN. In-hospital management of type 2 diabetes mellitus. Med Clin North Am. 2004;88:1085-1105.

11.    ch IB. Sliding scale insulin -- time to stop sliding. JAMA. 2009;301:213-214.