We recently asked nurse practitioner Jennifer Arnett to share her insight on diabetes care management. Jennifer has 12 years combined experience in the fields of endocrinology and internal medicine.
There are many aspects to diabetes care and management including sliding scale insulin. Sliding scales used to be the mainstay of diabetes management but this is no longer the case. We have learned that managing blood sugars with a sliding scale does not help improve the Hgb A1c. This is because it is treating the blood sugars retroactively, meaning the blood sugar gets high and then insulin is given. The best way to lower the Hgb A1c is to keep the blood sugars from getting high in the first place with scheduled insulin.
There are a couple of instances where sliding scale use is appropriate:
1. Upon admission until a pattern can be established. The goal here is no longer than two weeks.
2. Prednisone use or acute infection. It is difficult to titrate scheduled insulin with an acute illness because blood sugars are usually elevated and the patient’s intake is often varied and prednisone is usually tapered.
3. Brittle diabetics. There are those patients that are very difficult to control or are so noncompliant that conventional insulin regiments don’t work.
The other issue regarding sliding scale is the cost factor. A vial of oncology costs about $110. Every 28 days the facility has to open a new vial. So if only 100 units of insulin is being used with a sliding scale that is a significant cost factor for the patient and facility.
Please keep these thoughts in mind when managing diabetes.