Sliding Scale Insulin-Time to Stop Sliding

摘要

Certainly, SSI has evolved considerably since first described by Joslin more than 70 years ago.4 For decades, insulin doses were based on the amount of glycosuria (fractional urine glucose testing) for both inpatient and outpatient settings.5 Although glycosuria is no longer used for this indication, there is still the fundamental problem of clinicians and even health care systems having nonstandard-ized definitions of SSI. Usually, SSI involves use of regular insulin or a rapid-acting insulin analogue provided without any other scheduled short-acting or long-acting insulin,67 but there are variations. For example, in one recent study, SSI was defined as regular insulin provided prior to meals and at bedtime based on bedside blood glucose testing or every 6 hours for the patient who is not eating.8 Both clinicians and patients often refer to the use of SSI as the addition of insulin to previously scheduled prandial insulin. So how can the merits or inadequacies of SSI be discussed when they cannot evenbe defined?#