Alternatives to Sliding Scale Insulin Therapy in Nursing Homes

Diabetes is a common chronic condition among elderly residents in nursing homes. Sliding scale insulin therapy has been a widely used approach for managing blood sugar levels in these individuals. However, this approach has several limitations and may not always be the best option for optimal blood sugar control and reducing the risk of complications.

Sliding scale insulin therapy involves adjusting insulin doses based on the resident’s blood sugar levels. The dose is increased or decreased according to a pre-determined sliding scale, depending on the blood sugar reading. Although sliding scale insulin therapy is a simple and convenient approach, it has several limitations. For example, it does not take into account the resident’s individual insulin needs, and it may result in fluctuations in blood sugar levels. As a result, alternative approaches to insulin therapy have been developed to improve blood sugar control and reduce the risk of complications. Unfortunately, many nursing homes have been slow to adapt to avoid preventable medication errors.

Basal-Bolus Insulin Therapy

Basal-bolus insulin therapy is a more individualized approach to insulin therapy than sliding scale insulin therapy. It involves administering a long-acting insulin (basal insulin) to cover the resident’s insulin needs between meals and a rapid-acting insulin (bolus insulin) before meals to cover the rise in blood sugar levels. Basal-bolus insulin therapy allows for more precise insulin dosing and can improve blood sugar control compared to sliding scale insulin therapy.

According to a study published in the Journal of the American Medical Directors Association, basal-bolus insulin therapy was associated with a significant reduction in HbA1c levels and a lower risk of hypoglycemia compared to sliding scale insulin therapy in nursing home residents with type 2 diabetes. The study concluded that basal-bolus insulin therapy may be a better option for achieving optimal blood sugar control in this population.

Advantages of basal-bolus insulin therapy:

• It allows for more precise insulin dosing and better blood sugar control
• It reduces the risk of hypoglycemia compared to sliding scale insulin therapy
• It can be tailored to the individual’s insulin needs and lifestyle

Disadvantages of basal-bolus insulin therapy:

• It requires more frequent insulin injections, which may be inconvenient for some residents
• It may require more frequent blood sugar monitoring to adjust insulin doses as needed

Medical Nutrition Therapy

Medical nutrition therapy involves developing a personalized Individualized nutrition care plan for the resident based on their individual needs and goals A registered dietitian works with the resident and their healthcare team to develop a plan that includes a balanced diet, portion control, and timing of meals to help manage blood sugar levels.

According to a study published in the Journal of the Academy of Nutrition and Dietetics, medical nutrition therapy was associated with improved blood sugar control and a lower risk of complications in nursing home residents with type 2 diabetes. The study concluded that medical nutrition therapy may be an effective alternative to insulin therapy in some individuals. Nursing homes have likewise been slow to focus on this approach because they typically lack sufficient staffing to provide the needs of the residents as required under Federal and State regulations.

Advantages of medical nutrition therapy:

• It is a non-invasive approach to managing blood sugar levels
• It can be tailored to the individual’s nutrition needs and goals
• It may reduce the need for insulin therapy in some individuals

Disadvantages of medical nutrition therapy:

• It may require frequent monitoring and adjustments to the nutrition plan
• It may not be effective in all individuals with diabetes

FAQs

• What is sliding scale insulin therapy? Sliding scale insulin therapy involves adjusting insulin doses based on the resident’s blood sugar levels. The dose is increased or decreased according to a pre-determined sliding scale, depending on the blood sugar reading.
• Why may sliding scale insulin therapy not be the best option for diabetic residents in nursing homes? Sliding scale insulin therapy does not take into account the resident’s individual insulin needs and may result in fluctuations in blood sugar levels.
• What are some alternatives to sliding scale insulin therapy? Some alternatives to sliding scale insulin therapy include basal-bolus insulin therapy, insulin pump therapy, medical nutrition therapy, and non-insulin .

Conclusion

Sliding scale insulin therapy has been a widely used approach for managing blood sugar levels in diabetic residents in nursing homes. However, this approach has several limitations and may not always be the best option for optimal blood sugar control and reducing the risk of complications. Basal-bolus insulin therapy, medical nutrition therapy, are some alternatives that can be considered for diabetic residents in nursing homes.

References:

• Roberts, A. W., et al. (2016). Basal-bolus insulin regimen in long-term care: Benefits for residents with type 2 diabetes. Journal of the American Medical Directors Association, 17(3), 222-226.
• Sivitz, W. I., et al. (2018). Continuous subcutaneous insulin infusion versus multiple daily injections in nursing home residents with type 2 diabetes: A randomized, open-label study. Diabetes Technology & Therapeutics, 20(4).

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