I read with great interest the article by Queale et al.1 My experience with my hospitals' sliding scale insulin use is that hyperglycemia is a real problem, and physicians rarely treat patients with diabetes mellitus using the sliding scale regimen alone. However, I wonder if this problem is not a failure of the sliding scale insulin regimen itself but rather indicates that the doses chosen for the sliding scale regimen are incorrect. The sliding scale regimen used in my hospital and in the study by Queale and colleagues is 12 U of regular insulin at the upper limits of the scale. The sliding scale regimen that I prescribe is 20 U of regular insulin at the upper end of the scale; compared with the routine sliding scale regimen, I have had much better success maintaining the glucose levels in the acceptable range.
The sliding scale regimen I prescribe is