[Time to stop sliding scale insulin regimen]

Abstract

Hyperglycemia at admission is associated with complications and mortality. There is only little evidence, however, for beneficial effects of strict glycemic control during hospitalization. Strict glycemic control may prevent postoperative infections. Strict control can increase the risk of hypoglycemia, which is independently associated with mortality. The ideal glucose target values for patients admitted to a general ward range from 5.6 to 10 mmol/L, with consideration for higher targets in certain populations. The sliding scale insulin regimen stands as a hallmark prescription for medical interns in hospital settings, yet the evidence shows this regimen is ineffective. Guidelines have been advising against the sliding scale regimen for almost 20 years. We advocate a basal-bolus insulin regimen for the management of elevated glucose levels, while tolerating mild hyperglycemia.A transition away from sliding insulin towards basal-bolus insulin, has shown promising outcomes. Embracing a paradigm shift towards basal-bolus insulin regimens offers a more nuanced approach to glucose management, leading to better patient outcomes and a lower workload for healthcare providers.