Abstract
How many times have we looked for the easier way when caring for patients with diabetes? A number of examples come to mind: using a sliding-scale versus a pattern or algorithm approach to insulin; having patients run 200-mg/dl blood glucose levels versus normal blood glucose levels the majority of the time; or relying on the 5.07 filament test versus performing a more comprehensive foot exam. These are but a few instances in which easier is not always better for our patients. Doing what we've always done because it's easier (such as using sliding scales), or, conversely, dropping tried and true practices because an apparently simpler method gains favor, can result in “throwing the baby out with the bathwater.” Hopping from one procedure or goal to another without an overall integrated approach to care can decrease the overall quality of care we provide for our patients. A few years ago, I asked a physician why he used a sliding-scale approach to insulin. His reply: “I don't want to be called unnecessarily.” But is what's best for his schedule and workload also best for his patients? The sliding scale is still in common usage, although there is no scientific documentation that it is either a safe or an effective way to manage insulin therapy.1 We know that a blood glucose level reflects the body's response to previous insulin, food, and activity; it …
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