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.



Sliding Scale


swings in blood glucose throughout the day



significant hyperglycemia

time between onset and correction may be prolonged

can be prevented or minimized

risk of hypoglycemia




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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