Basal-bolus insulin versus sliding scale insulin for managing blood sugar levels in hospitalized diabetic patients

Basal-bolus insulin management via subcuteous injection is now recommended for inpatient glycaemic control. This replaces the old subcutaneous injection sliding scale insulin management approach. This study will prospectively collect performance data around a basal-bolus insulin approach developed at this hospital and compare it to retrospective data around the use of sliding scale insulin management at the hospital. Four times daily capillary blood glucose will be recorded in each group. Subcutaneous sliding scale insulin is initiated at the doctors discretion and the quantitative adjustment within the sliding scale is empirical, depending on what insulin doses the doctor feels are appropriate for that particular patient. Frequency of insuin administration is generally four times daily but may vary. This is continued until either discharge or the treating doctor feels the patient will maintain satisfactory glycaemic control without sliding scale insulin intervention, with a maximum data collection of 1 week. This data will be collected retrospectively as the hospital has now switched over to a basal-bolus insulin management approach. The basal-bolus insulin management (via subcutaneous injection) is intiated at the discretion of the treating doctor. An initial daily insulin dose is calculated according to set criteria, and 50% of this is then divided into a basal (glargine) dose administered once daily and 50% to rapid-acting insulin split into bolus doses three times daily prior to each meal +/- a small dose of correctional insulin depending on the blood glucose level at the time. This is continued until either discharge or the treating doctor feels the patient will maintain satisfactory glycaemic control without basal-bolus insulin intervention, with a maximum data collection of 1 week.