Sliding scale insulin dosing leads to more missed doses

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More doses of insulin are missed when using sliding-scale insulin dosing to manage hospital patients’ blood glucose levels compared with basal–bolus dosing, according to a study published in the Journal of Pharmacy Practice and Research.

Researchers Greg Roberts and Gauri Godbole reviewed the difference between the two methods of insulin dosing after the Repatriation General Hospital in Adelaide switched to basal–bolus dosing. What they discovered surprised them.

“I expected to find a few missed doses due to the nature of the workflow for the sliding scale insulin that was in place, but was surprised by how many missed doses there were,” says Greg Roberts.

Worryingly, more than a quarter of insulin doses were missed on the first day of admission when using sliding-scale dosing compared with just 7% for basal–bolus dosing.

Sliding-scale dosing involves calculating the dose of rapid-acting insulin based on the patient’s blood glucose level. Basal–bolus dosing consists of a daily dose of long-acting insulin for background control with doses of short-acting insulin at mealtimes and top-up doses of insulin if required.

Previous studies have shown that basal–bolus dosing is superior to sliding-scale dosing for controlling patients’ blood glucose levels in the hospital setting.

Apart for some seriously ill patients, basal–bolus insulin dosing is now the recommended method of insulin dosing in hospitals.

“Acute illness often causes temporarily increased blood sugar levels in hospitalised patients, and basal–bolus dosing can be used for short-term control in these patients,” says Roberts.

Not all hospitals have been able to adopt the recommended changes quickly. Roberts says he hopes his study highlights the importance of making the switch.

“Each hospital needs a champion for change,” he says.

“I hope hospital pharmacists become those champions. The previous practice of sliding-scale insulin was well entrenched over several decades, adding to the difficulty in changing that practice.”

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