HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Childs, B. P. Search for Related Content PubMed Articles by Childs, B. P. Social Bookmarking                What's this?

Death to the Sliding Scale!

The first 20% of the full text of this article appears below.

The practice of sliding-scale insulin management persists even though it has been called "a relic from the past" that "should be left in the medical history books."¹ It remains a common practice in many health care settings. And, in my opinion, it is a prime example of a diabetes treatment strategy that makes no sense but that many providers continue to employ without regard for common sense or science.

Some would say that the argument surrounding the practice of sliding-scale insulin administration is merely a matter of semantics and that, in today’s world of basal-bolus insulin regimens, "sliding scales," "correction boluses," "algorithms," and "supplemental insulin" are really just the same thing. I would contend that, in some cases, correction boluses, algorithms, and supplements are actually sliding scales in disguise and, as such, are problematic.

Still, this editorial will focus on the old concept of a sliding scale—a concept that is still alive and well throughout the United States. It is still used by many physicians, and it is still taught to many of our health care students and medical residents. Sliding scales are not found in students’ textbooks, but they are still learned through observation and practice.

My impetus for writing this editorial came from a recent personal experience that left me frustrated and angry—frustrated over how my own father-in-law’s diabetes was being managed in a hospital setting, and angry because I could not protect him from the effects of an outdated insulin management strategy that remains pervasive despite numerous studies illustrating its shortcomings and editorials calling for its demise.²–⁵

Over the past several years, my father-in-law has been hospitalized repeatedly for treatment of complications related to . . . [Full Text of this Article]

CiteULike    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

				C. L. Thompson, K. C. Dunn, M. C. Menon, L. E. Kearns, and S. S. Braithwaite Hyperglycemia in the Hospital Diabetes Spectr, January 1, 2005; 18(1): 20 - 27. [Abstract] [Full Text] [PDF]