Sliding scale insulin: will the false idol finally fall?

Despite a lack of evidence that sliding scale insulin has any clinical benefit, and some evidence that it may even be detrimental, sliding scale insulin is still commonly prescribed in hospitals today. Adopting a proactive rather than a reactive approach to managing diabetes by the use of 'supplemental insulin', given in conjunction with either considered adjustments to the patient's regular anti-diabetic therapy or the provision of basal insulin, is a more effective and safer means of improving glycaemic control in hospital. There are now randomized trial data to support this approach. These data, together with the recognition that there is no evidence base for the use of sliding scale insulin, coupled with changes to insulin prescribing charts in Australia, should lead to the demise of sliding scale insulin use in hospital.