Sliding Scale Insulin: The "Roller Coaster" Regimen That Hospitals and Nursing Homes Still Can't Quit
Over one-third of U.S. nursing home residents with diabetes are managed on sliding scale insulin alone, a method that multiple medical societies have flagged as potentially inappropriate for long-term use. The core problem: sliding scale insulin only reacts to high blood sugar after it happens. It never prevents it. Expert reviews describe the result as a "roller coaster" glucose pattern, and the research consistently shows it leads to worse control and more hypoglycemia than alternatives. Yet it persists. Understanding why, and when it might still make sense, matters if you or someone you care about is being managed this way in a hospital or nursing home.