It has been a long time since I have written a new blog. Lately, I have been very busy with my consulting job. Since the beginning of the year, I have participated in three state inspections in my long term care facilities. Recently, I walked into an inspection on my first day at work in a new building. The state inspector was concerned about a female resident who was on NPH insulin twice a day and not meeting her blood glucose goals. She constantly needed sliding scale insulin coverage because her blood sugar was usually between 200 to 300mg/dl. The inspector wanted to know why nobody asked the doctor to change her insulin regiment to prevent excessive sliding scale insulin coverage. I have to commend this inspector because apparently this person is very knowledgeable about diabetes care. Sadly, many health care professionals are not quite as astute. I will explain in this blog why using a sliding scale insulin regiment does not make sense:

1. Sliding scale insulin treats the symptom but not the problem.

Sliding scale insulin is used as an emergency measure to correct high blood sugar. However, many people do not ask themselves, “Why is my blood sugar too high?” If you need extra insulin you may be on the wrong blood glucose medications. Many oral medications take some time to actually start working and you will need insulin coverage for a short period. However, if you still need to take sliding scale insulin after several weeks of starting the pills, your blood glucose medication is not working. At this point, your blood sugar medication needs to be adjusted. Also, high blood sugar may be a sign of an infection or dehydration. Many people tend to ignore these issues because they can just take extra insulin.

2. Sliding scale insulin is not individualized.

Many hospitals have a routine protocol for giving sliding scale. The protocol is a “one size fits all” approach. What many standard medical professionals do not realize is everyone has their own sliding scale or “correction bolus” of insulin. This dosage is based on the person’s weight, type of diabetes (I or II) and insulin resistance. In addition, people with an infection usually need extra insulin. Several studies show sliding scale insulin as a solo treatment for diabetes is only effective for about 33% of individuals.

3. It is too late.

Once a person's blood sugar is too high the damage has already been done. Giving people with diabetes insulin after their blood sugar is too high is like giving people with heart disease medication after they had a heart attack. It seems more logical to give someone with diabetes or heart disease the proper medications before something bad occurs.

I hope this blog was informational for you and I apologize with waiting so long to write a new blog. Email me at askard@stablebloodsugar.com if you have any questions. Allison