In the past many diabetics in the hospital were managed with sliding scale insulin (SSI). Today this practice is discouraged in favor of scheduled insulin based on carbohydrate loads.
Sliding scale insulin involves giving a dose of insulin every few hours based on a patient's level of hyperglycemia.
Scheduled insulin regimens consist of basal and prandial insulin doses with supplemental correction doses based on premeal hyperglycemia.
Parameter
Sliding Scale
Scheduled
swings in blood glucose throughout the day
wide
narrow
significant hyperglycemia
time between onset and correction may be prolonged
can be prevented or minimized
risk of hypoglycemia
lower
higher
philosophy
responding after the fact (reactive)
before the fact (proactive)
relation to carbohydrate load
often unrelated
in tune with
level of care
simplistic but unpredictable
sophisticated and standardized
It is not uncommon for a sliding scale regimen started on hospital admission to be used throughout the admission even when it is performing poorly.
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