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A Novel Insulin Sliding Scale-Reply

Frederick L. Brancati, MD, MHS; William S. Queale, MD, MS
Arch Intern Med. 1997;157(21):2524. doi:10.1001/archinte.1997.00440420162019.
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Trochtenberg suggests that sliding scale insulin regimens that reach a maximum of 20 U of insulin may perform better than those that stop at 12 U. Because the physicians in our study' generally did not prescribe such aggressive sliding scale insulin, we are unable to test this hypothesis directly. Nonetheless, we question this hypothesis for several reasons. First, there was no apparent association in our study between the type of sliding scale and the performance: aggressive scales performed as poorly as conservative scales. Second, the use of very aggressive sliding scale insulin should only increase the risk for hypoglycemia. Third, the beneficial effects of very aggressive sliding scale insulin on hyperglycemia are likely to be short-lived unless the underlying long-acting hypoglycemic regimen is modified accordingly. In light of Trochtenberg's comment that he "rarely treat[s] patients with diabetes mellitus using the sliding scale regimen alone," we suspect that the apparent success


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