Friday, April 25, 2008

Managing insulin in the hospital

There’s a nice little review in Today’s Hospitalist on the subject. The diabetes Nazis have made the term “sliding scale” taboo. While basal-bolus regimens are more rational the “correction” component of short acting bolus regimens is nothing more than a sliding scale, as are popular insulin drip protocols. Moreover, basal bolus regimens are problematic in hospitalized patients:

While basal-bolus regimens, also known as physiologic insulin, are the preferred way to give insulin to patients in the hospital, these regimens bring their own set of challenges. Inpatients may be eating one minute, then being told to stop for a procedure, throwing up or being switched to an entirely different type of feeding.

The review presents practical tips to deal with these situations. It’s really a very helpful article but I had to chuckle at this:

At Loyola University Medical Center in Chicago, on the other hand, the protocol for patients with continuous tube feeds calls for one shot of slow-release glargine, plus a blood sugar check every six hours “and using correction factor dosing to lower an elevated glucose,” says Mary Ann Emanuele, MD, a professor of endocrinology and medicine.

The “correction factor” sounds a lot like a sliding scale although none dare call it that.

1 comment:

Stalwart Hospitalist said...

The point is not necessarily to demonize the phrase "sliding scale," or to avoid using short-acting insulins to correct and/or manage glucose -- the point is to move away from using a sliding scale as the ONLY modality of glycemic control in inpatients, as this can frequently result in wide swings in serum glucose.

Diabetic patients who are NPO often still require some amount of insulin to maintain euglycemia.