Insulin administered in response to current blood glucose alone can compound a prior dosing error, which can lead to significant fluctuations in high and low blood glucose levels. If rapid-acting insulin is given with the previous meal and its effects last only three or four hours, then the patient may experience high blood glucose levels for several hours prior to the next dose of insulin being given.9. Premeal blood glucose levels do not accurately predict the insulin needed at that time but rather reflect the activity of insulin previously given. Patients typically have finger-stick blood sugars done every 6 hours or prior to meals and before bedtime. Subsequently, the 80-kg patient may not receive sufficient insulin, placing him or her at increased hyperglycemia risk, and the 65-kg patient may receive a potentially excessive dose that could result in hypoglycemia. In 2012, the American Geriatrics Society increased its focus on sliding-scale insulin by updating the Beers criteria for potentially inappropriate medication use in the elderly to avoid its use due to a higher risk of patients experiencing hypoglycemia without an improvement in the management of hyperglycemia, regardless of setting.7. Of those patients not started on it, 33 were later switched from other diabetic regimens to sliding-scale insulin.6. Vero visi 20 keygensĪdditionally, patients on these regimens experienced blood glucose levels greater than 300 mgdL at a rate three times that of patients on other insulin regimens that were more intensive and physiological based.4.Ī retrospective observational study conducted at a large medical center observed 84 of patients on sliding-scale insulin experienced hyperglycemia, with dosage adjustments occurring in only 18 of these patients.5.įifty-four percent of the patients were started on sliding-scale insulin during their stay, and 22 of all insulin orders in the facilities involved a sliding-scale regimen.Įighty-three percent of the residents started on sliding-scale insulin remained on the regimen at the end of the study. Issues related to hypoglycemia, when severe and left untreated, can lead to unconsciousness, seizures, coma, or even death.1.
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