Impact of a standard insulin sliding scale on the efficacy of controlling blood glucose levels in the critically ill

Abstract

We tested the hypothesis that a standard insulin sliding scale as a starting point for insulin therapy in the critically ill would improve control of blood glucose levels as evidenced by decreased times to achieve a blood glucose level (BGL) of less than 10 mmol litre−1 from the commencement of intravenous insulin. The current practice guidelines dictate that BGL's should initially be done hourly when abnormal and insulin therapy started if the BGL is greater than 10 mmol litre−1 for 3 h. We audited the efficacy of these guidelines over a 4-week period and repeated this process following introduction of a standard insulin sliding scale (Table 34) as a starting point for insulin therapy. There were 15 patients who required insulin infusions in the first 4-week period. The mean time taken to initiate therapy following the third abnormal BGL was 3.3 h and to achieve a BGL of The use of a standard sliding scale seems to facilitate more expedient control of blood glucose levels and its introduction increased compliance with established practice guidelines. The small sample size does not achieve statistical significance.