Easy and flexible carbohydrate counting sliding scale reduces blood glucose of hospitalized diabetic patient in safety



      The in-hospital sliding scale (Sc) to determine the insulin dose was changed to a carbohydrate counting sliding scale (CSc). Blood glucose levels before and after the change were compared.


      The Sc was used in 32 patients in July and August 2009 (Sc group) and the CSc was used in 32 patients in September and October 2009 (CSc group). The blood glucose levels recorded before breakfast, lunch, and supper for 14 days were analyzed. The overall and daily mean of all blood glucose data were compared between the 2 groups.


      The overall blood glucose level was significantly lower in the CSc group than in the Sc group (p < 0.001). The percentage of blood glucose level below 199 mg/dL was 47% in the Sc group and 59% in the CSc group. The daily blood glucose level in the Sc group was 203–229 mg/dL until day 14, while the daily mean blood glucose level decreased significantly to 186 mg/dL on day 4 in the CSc group and remained in the 176–200 mg/dL range on subsequent days (p = 0.049).


      The CSc is easy to use, safe and useful in controlling the blood glucose level.


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        • van den Berghe G.V.
        • Wouters P.
        • Weekers F.
        • Verwaest C.
        • Bruyninckx F.
        • Schetz M.
        • et al.
        Intensive insulin therapy in critically Ill patients.
        N Engl J Med. 2001; 345: 1359-1367
        • Robbins L.
        Let's get the sliding scale out of medicine.
        Med Rec Ann. 1963; 56: 201
        • Hirsch I.B.
        Sliding scale insulin-time to stop sliding.
        JAMA. 2009; 301: 213-214
        • Childs B.P.
        Death to the sliding scale!.
        Diabetes Spectrum. 2003; 16: 68-69
        • Dickerson L.M.
        • Ye X.
        • Sack J.L.
        • Hueston W.J.
        Glycemic control in medical inpatients with type 2 diabetes mellitus receiving sliding scale insulin regimens versus routine diabetes medications: a multicenter randomized controlled trial.
        Ann Fam Med. 2003; 1: 29-35
        • The Diabetes Control and Complication Trial Research Group
        Implementation of treatment protocols in the diabetes control and complications trial.
        Diabetes Care. 1995; 18: 361-376
        • DAFNE Study Group
        Training in flexible, intensive insulin management to enable dietary freedom in people with type 1 diabetes: dose adjustment for normal eating (DAFNE) randomised controlled trial.
        BMJ. 2002; 325: 746
        • Hope S.W.
        • Karmeen K.
        Complete guide to carb counting.
        American Diabetes Association, Virginia2004
      1. The Committee of Japan Diabetes Society on the diagnostic criteria of diabetes, mellitus. Report of the Committee on the classification and diagnostic criteria of diabetes, mellitus.
        J Jpn Diabetes Soc. 2010; 53: 450-467
        • Donihi A.C.
        • DiNardo M.M.
        • DeVita M.A.
        • Korytkowski M.T.
        Use of a standardized protocol to decrease medication errors and adverse events related to sliding scale insulin.
        Qual Saf Health Care. 2006; 15: 89-91
        • Rabasa-Lhoret R.
        • Garon J.
        • Langelier H.
        • Poisson D.
        • Chiasson J.L.
        Effects of meal carbohydrate content on insulin requirements in type 1 diabetic patients treated intensively with the basal-bolus (ultralente-regular) insulin regimen.
        Diabetes Care. 1999; 22: 667-673
        • Tamborlane W.V.
        • Swan K.
        • Sikes K.A.
        • Steffen A.T.
        • Weinzimer S.A.
        The renaissance of insulin pump treatment in childhood type 1 diabetes.
        Rev Endocr Metab Disord. 2006; 7: 205-213
        • American Diabetes Association
        Standards of medical care in diabetes-2009.
        Diabetes Care. 2009; 32: S13-S61
        • Hassan E.
        Hyperglycemia management in the hospital setting.
        Am J Health Syst Pharm. 2007; 64: S9-S14
        • Walsh J.
        • Roberts R.
        • Bailey T.
        Guidelines for optimal bolus calculator settings in adults.
        J Diabetes Sci Technol. 2011; 5: 129-135