Question: Sliding Scale orders for insulin is time consuming and sometimes confusing. Is there a better way to prescribe insulin for elderly patients?
Answer: According to recent guidelines published in February 2017 by the American Diabetes Association sliding-scales are NOT RECOMMENDED in long-term care.
Diabetes affects up to 33% of patients in long-term care facilities The most commonly prescribed insulin therapy for patients in long-term care is sliding-scale insulin (SSI), the use of finger-stick blood glucose testing to assess the need for insulin administration based on current blood glucose levels. Its sole use for long-term treatment is specifically not recommended
Recent updates to several published guidelines, including CMS, the Beers criteria, the American Medical Directors Association, and the American Diabetes Association regarding the use of SSI-only insulin regimens for elderly patients in long-term care all advise simplified treatment regimens and avoidance of “sliding-scale” regimens.
Below is a summary of the recommendations:
- Hypoglycemia risk is the most important factor in determining glycemic goals due to the catastrophic consequences in this population.
- Simplified treatment regimens are preferred and better tolerated.
- Sole use of SSI should be avoided.
- Liberal diet plans have been associated with improvement in food and beverage intake in this population. To avoid dehydration and unintentional weight loss, restrictive therapeutic diets should be minimized.
- Physical activity and exercise are important in all patients and should depend on the current level of the patient’s functional abilities.