Sliding scale
Formal Definition
A reactive insulin dosing protocol in which supplemental rapid-acting insulin is given based on a patient's current blood glucose measurement according to a fixed table of glucose ranges and corresponding insulin units — given after a meal or glucose check rather than proactively.
How It's Used on the Ward
"On a sliding scale" or "just sliding scale insulin" — the most common inpatient insulin order, and frequently criticized as inadequate for truly brittle or insulin-dependent diabetics.
Example
""Type 2 DM on metformin outpatient, admitted for cellulitis: sliding scale insulin ordered. Glucose 280 on admission → 4 units aspart per scale. Down to 195 by morning. For a poorly controlled type 1, you'd need basal-bolus instead — sliding scale alone doesn't cover the background insulin requirement.""
Clinical Context
Sliding scale insulin is reactive — it treats hyperglycemia after it happens rather than preventing it. It's appropriate for mild glucose elevations in patients not eating or with mild diabetes. It is NOT appropriate as the sole insulin regimen for type 1 diabetes or insulin-dependent type 2 — these patients need scheduled basal insulin plus correction. The ADA recommends basal-bolus regimens for most hospitalized diabetic patients. "SSI only" in an insulin-dependent patient is a common and dangerous order set default.
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