Building Competency in Diabetes Education THE ESSENTIALS

BASAL-BOLUS INSULIN THERAPY | 12-52

Correction factor used to create a sliding/variable insulin dose scale for BBI The term “sliding scale” has earned a bad reputation due to the past misuse of this tool. Insulin was provided retrospectively based on an amount of glucosuria in scales of the 1960s and 1970s (122). In the 1980s and 1990s, scales provided insulin non-physiologically based retrospectively on the BG level, but irrespective of timing of food intake. The correct use of a scale is to provide insulin prospectively, with the dose calculated to provide the correct amount of insulin that will lower BG from elevated range to target range and prevent excessive excursions from usual food intake. This emphasizes the need for physiological replacement of insulin that provides prospective basal and bolus insulin as needed. Prior to the results of the DCCT, most patients with diabetes had a fixed insulin dose. However, since BG levels are not always in the goal range, the use of a variable insulin dose scale (VIDS) increases patient success with BG control. The VIDS is a scale of increasing or decreasing rapid/short-acting insulin doses to correct for previous dose “estimate error” and to respond immediately to a BG reading that is outside the goal range (Figure 7).