![]() Insulin sensitivity, nutritional intake, and total daily dosing review can alter the physiologic insulin-dosing schedule. This correctional dose resembles a sliding scale, but is only a small fine-tuning of therapy, as opposed to traditional sliding-scale insulin alone. A correctional insulin dose provides a final insulin adjustment based on the preprandial glucose value. The initial total daily dose of subcutaneous insulin is calculated using a factor of 0.3 to 0.6 units per kg body weight, with one half given as long-acting insulin (the basal insulin dose), and the other one half divided daily over three meals as short-acting insulin doses (nutritional insulin doses). New physiologic subcutaneous insulin protocols use basal, nutritional, and correctional insulin. ![]() Evidence for the effectiveness of sliding-scale insulin is lacking after more than 40 years of use. Despite persistent expert recommendations urging its abandonment, the use of sliding-scale insulin remains pervasive in U.S. Glycemic control in hospitalized patients who are not in intensive care remains unsatisfactory.
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