Insulin Sliding Scale - Is it good? Is it bad?
Today, we will be discussing about a controversial approach in diabetic therapy - The Insulin Sliding Scale. The Insulin Sliding Scale is a set of procedure used by doctors to determine the amount of insulin required at a specific glucose level, and to provide dosage according to glucose tests (3). The insulin given in this process are fast- or rapid-acting and is given when glucose levels are particularly high (4). Administered to patients who has hyperglycemia or high blood sugar, this scale is used primarily in a health institution setting rather than daily use for patients at home (3).
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| Insulin Chart for Diabetes http://www.safehavenpch.com/speciality-care/diabetes-management/ |
Since the scale has been around for 80 years and many physicians and therapists still continue to use this method, it may seem to have made a breakthrough in the realm of diabetic therapy (3). The higher the glucose reading from the test, the greater the amount of insulin that should be given (3) - this seems to make sense right? What actually occurs is that the use of this method has not proven to stabilize a patients blood glucose level but rather causes patient’s glucose level to become out of control (3).
An argument against this method is it does not manage the blood glucose level, but rather “chases” it (1). Since a blood test is required before hand to determine the amount of dosage, the patient will already be at that specific level of blood sugar; the dose will simply comply with the amount of blood sugar at that time (3). Another perspective for opposing this procedure is that doctors may use this to reduce their own botheration (1). The doctors will not be continually called while a patient is in the hospital, as the nurse would be able to apply the scale to administer insulin (1).
Despite all the arguments made against the Insulin Sliding Scale, this practice continues to prosper in academic medical centers and community hospitals (2). The scale is a “Historical Practice Habit” (4). Thus, breaking these habits and practices would require a lengthy amount of time because it is deeply entrenched (4). Alternatively, the process is convenient and straightforward; nurses will be able to administer insulin while doctors handle other more severe cases (2).
My perspective on this Insulin Sliding Scale is quite gray; It depends on the standard of living and whether funding is sufficient in a specific location. For example, if funding for health care is high and the cost is low, I agree to removing this procedure from hospitals and other health institutions. More doctors would be readily available to attend to patients On the other hand, if funding for health care is low and costs are high, then there are fewer options for institutions. There is no perfect solution; whatever we gain for ease, we pay for it in terms of costs.
Sources Cited:
1) DiabetesLife (n.d.) Insulin Scale - What’s the Whole Controversy About? Retrieved from:
http://www.diabitieslife.com/diabetes/diabetes-basics/treatment-of-diabetes/insulin-sliding-scale.htm
http://www.diabitieslife.com/diabetes/diabetes-basics/treatment-of-diabetes/insulin-sliding-scale.htm
2) Hirsch, B. I. (2009). Sliding Scale Insulin - Time to Stop Sliding. Retrieved from:
3) Insulin Sliding Scale (n.d.). Insulin Sliding Scale - A Controversial Approach Diabetic Therapy.
Retrieved from: http://www.insulinslidingscale.net
4) Miller, D. (2011). Why Won’t the Sliding Scale Go Away?. Canadian Diabetic Association.
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