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Queale and colleagues¹ have provided valuable information for those taking care of inpatients with diabetes by pointing out the pitfalls of relying on a sliding scale insulin regimen alone to obtain optimal glycemic control. However, the problem of how to treat the patient with diabetes in the hospital remains. Their suggestion to continue the outpatient insulin regimen is certainly a good start, but does not adequately address issues of increased insulin demand during illness and changing insulin needs during periods of reduced energy intake or patients with "nothing by mouth" status in the hospital.

Our clinical experience indicates that sliding scale insulin regimens can be used effectively in the hospital if approached in a manner similar to how we teach outpatients to use insulin.

We first establish a usual daily dose of insulin based on evaluating patterns of glucose readings. We then teach outpatients to make insulin adjustments for daily . . . [Full Text of this Article]

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