Sliding scale insulin therapy is widely used in long-term care settings despite poor glycemic control, increased risk for hypoglycemia, and high burden of care. The Beer’s List has identified sliding scale insulin therapy to be a potentially high-risk therapy for patients 65 and older regardless of care settings, and the ADA determined that sole sliding scale insulin therapy should be avoided in LTCF. Although there is no current clinical guideline on how to convert residents from sliding scale insulin therapy to basal therapy, the ADA has provided several strategies depending on the current therapy.
Clinicians converting residents from sole sliding scale therapy to basal therapy can:
- Calculate the average daily insulin dose during the previous 5 to 7 days.
- Apply 50% to 75% of that daily dose as the initial basal insulin dose.
- Discontinue the sliding scale.
Non-insulin agents or fixed-dose mealtime insulin can be used for postprandial hyperglycemia. Basal insulin can be given in the morning to impact postprandial hyperglycemia and reduce the risk of early morning hypoglycemia.  For more information or strategies for managing diabetes in skilled nursing settings, view Management of diabetes in long-term care and skilled nursing facilities: a Position Statement of the American Diabetes Association at http://care.diabetesjournals.org/content/39/2/308.full