Sliding-Scale versus Basal-Bolus Insulin in the

Management of Severe or Acute Hyperglycemia

in Type 2 Diabetes Patients

.
A retrospective study was conducted using the
medical records of patients with acute or severe
hyperglycemia admitted to a hospital in Malaysia
from January 2008 to December 2012.(published in
sep 2014) A total of 202 patients and 247 admissions
were included. Patients treated with the basal-bolus
insulin regimen attained lower fasting blood glucose
(10.82.3 versus 11.63.5 mmol/L; p=0.028) and
mean glucose levels throughout severe/acute
hyperglycemia (12.31.9 versus 12.82.2; p=0.021)
compared with sliding-scale insulin regimens
.
It was found that DKA, cardiovascular diseases and
acute exacerbation of bronchial asthma appeared to
have a significant association with the insulin
regimens used in glycemic control.DKA was more
common with SSI. A study focusing on
cardiovascular disease reported that the strict control
of preprandial and postprandial hyperglycemia
resulted in the reduction of cardiovascular disease
among T2DM patients [11]. Thus, treatment of
severe or acute hyperglycemia secondary to
cardiovascular diseases with a basal-bolus insulin
regimen is reasonable, Overall, this study revealed
that lower blood glucose levels were achieved with a
basal-bolus insulin regimen compared with sliding-
scale insulin in the population studied.
.
The results of this study also demonstrate significant
differences in cases of hypoglycemia (defined as
blood glucose <3.3 mmol/L) between basal-bolus
insulin and sliding-scale insulin regimens (p=0.005).
The use of sliding-scale insulin and basal-bolus
insulin resulted in 10.1% and 2.5% cases of
hypoglycemia, respectively.
.
Randomized study comparing basal bolus with basal + correction insulin
regimen for hospital management of patients with type 2 diabetes: Basal Plus
Trial
Umpierrez GE, Smiley D, Hermayer K, et al. Randomized study comparing a basal
bolus with a basal plus correction insulin regimen for the hospital management of
medical and surgical patients with type 2 diabetes: Basal Plus Trial. Diabetes
Care. 2013;36(8):2169-2174.


This study explored the hypothesis that a single daily dose of basal insulin plus one
other corrective dose of glulisine as needed with a meal might result in similar
glycemic control and a lower rate of hypoglycemia than a basal bolus regimen.
Basal bolus: glargine once daily, glulisine before meals, corrective doses of
glulisine by sliding scale for BG >140 mg/dL
Basal plus: glargine once daily, corrective glulisine given by sliding scale
before meals for BG >140 mg/dL
Regular SSI (no basal insulin): for BG >140 mg/dL

A total of 375 subjects (aged 18 to 80 years) with type 2 diabetes treated with diet,
oral antidiabetic agents (OADs), or low-dose insulin (4 units/kg/day) were enrolled.
Prior to randomization, BG was between 140 and 400 mg/dL; subjects were recruited
when BG was >140 mg/dL. OADs were stopped at admission

.
The percentage of glucose readings within the 70-
140 mg/dL target range was highest with the basal
plus regimen (42%) compared with the basal bolus
(37%) and the SSI (32%) regimens (P=0.04). The
percentage of glucose readings >180 mg/dL was
lower in the basal bolus group (27%) compared with
the basal plus (32%) and SSI (38%) regimens
(P=0.11).
get blood pressure checked in both arms,
rather than just in one. Why?
.
A big difference between the two readings can give
you an early warning about increased risk of
cardiovascular disease, a new study suggests.
.
Researchers at Harvard-affiliated Massachusetts General Hospital
and colleagues measured blood pressurein both armsin nearly
3,400 men and women age 40 or older with no signs of heart
disease. The average arm-to-arm difference was about 5 points in
systolic blood pressure. About 10% of the study participants had
differences of 10 or more points. Over the next 13 years or so,
people with arm-to-arm differences of 10 points or more were 38%
more likely to have had a heart attack, stroke, or a related problem
than those with arm-to arm differences less than 10 points. The
findings, which appear in the March 2014 American Journal of
Medicine, uphold earlier work on arm-to-arm differences in blood
pressure.
small differences in blood pressure readings between the
right and left arm are normal. But large ones suggest the
presence of artery-clogging plaque in the vessel that
supplies blood to the arm with higher blood pressure.
Such plaque is a signal of peripheral artery disease
(cholesterol-clogged arteries anywhere in the body other
than the heart). When peripheral artery disease is
present, theres a good chance the arteries in the heart
and brain are also clogged, boosting the odds of having a
heart attack or stroke
Heres another reason to check blood pressure in both
arms: if the pressure in one arm is higher, that arm should
be the one upon which to base any treatments and to
check your blood pressure in the future