Advantages & Disadvantages of Sliding Scales

Diabetics monitor their blood sugar levels frequently to determine their need for insulin. In most cases, specific insulin amounts are prescribed for set intervals throughout the day in conjunction with the patient’s normal daily routine. However, patients’ lives are not the same every day, and breaks in daily patterns such as sicknesses can cause blood sugar variations. In an effort to customize insulin doses to a patient’s immediate needs, doctors created sliding-scale insulin.

Purposes

• Sliding scales are not meant for everyday use. Doctors create sliding scales for patients when insulin intake needs to be as close to precise as possible. A common use for a sliding scale is during illness, because some medications require a patient’s blood sugar to remain at a certain level. Some illnesses also cause a patient’s food intake to decreases, which affects blood sugar levels and requires an adjustment to insulin using a sliding scale.

Advantages

• Sliding-scale insulin doses have the potential to quickly control hypo- and hyperglycemic events -- which consist of dangerously low and high blood sugar levels, respectively -- when patients are experiencing abnormal blood sugar levels. Nurses and other certified floor staff such as medical residents can administer insulin based on the suggested sliding-scale doses, freeing up time doctors could spend on more serious patient needs. Allowing nurses and medical staff to monitor patient blood sugar levels and administer appropriate insulin doses using a sliding scale also helps outpatients manage blood sugar levels and insulin doses without being admitted to a hospital.

Disadvantages

• Nurses and medical staff operating sliding-scale insulin regimens must be formally instructed by diabetologists on how to care for patients with glycemic events. However, eliminating a sliding scale requires the medical facility to adopt standard guidelines that apply to all inpatients. Some guidelines may not be appropriate to individual patients' circumstance, so patient education regarding diet must be coupled with insulin dose suggestions. This process helps prevent blood sugar variations, but it is time-consuming and not widely implemented or entirely accepted throughout medical facilities.

Considerations

• Doctors have mixed opinions on using sliding-scale insulin because this technique is a traditional practice. Further, experiments comparing the two methods are inconclusive about their comparative effectiveness.