Things We Do For No Reason: Sliding‐Scale Insulin as Monotherapy for Glycemic Control in Hospitalized Patients

Abstract

The "Things We Do for No Reason" (TWDFNR) series reviews practices that have become common parts of hospital care but may provide little value to our patients. Practices reviewed in the TWDFNR series do not represent "black and white" conclusions or clinical practice standards but are meant as a starting place for research and active discussions among hospitalists and patients. We invite you to be part of that discussion.

COVID-19 infection in Italian people with diabetes: Lessons learned for our future (an experience to be used)

“…In fact, when insulin is used at fixed doses or according to the so called ''sliding scale", 1 blood glucose is bound to undergo several oscillations around the desirable mean by often getting into the hypoglycemic range and into the hyperglycemic soon after [36,37], which is technically referred as ''glycemic variability" [38]. Now, hypoglycemia has been shown to potentiate host's innate immune reaction to endotoxins by mobilizing pro-inflammatory monocytes with negative consequences on cardiovascular mortality [39].…”

Things we do for no reason™: Routinely holding metformin in the hospital

“…The practice of replacing metformin with sliding-scale insulin monotherapy for hospitalized patients significantly increases the risk of hyperglycemia and is associated with an increased length of stay. 19 Additionally, unlike…”

Predicting Inpatient Glucose Levels and Insulin Dosing by Machine Learning on Electronic Health Records

“…one unit of insulin for every 50mg/dL that the glucose is >150mg/dL) can be given in addition to basal-bolus regimens or without any other scheduled insulin 9 . Some form of SSI therapy has been around since the 1930s and is popular in hospitals 10 . However, because it treats hyperglycemia after it had already occurred, SSI alone is a reactive strategy, and is not effective at glucose control 8,11 , especially when compared to a basal-bolus regimen in hospitalized diabetic patients 8,12 .…”