Action Without Benefit

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Abstract
IN ANY LARGE HOSPITAL that cares for acutely ill patients with diabetes mellitus, particularly if it is a teaching hospital, one will find many patients treated with the so-called sliding scale of insulin use. This regimen attempts to control blood glucose levels with doses of regular insulin every 6 hours, with the dose calculated on the basis of the value of capillary blood glucose measured at the bedside. The practice is so common and widespread that its efficacy or benefit is rarely questioned; it is done because it is expected. In my experience, there is also an overtone of busyness; if one measures a lot and does a lot, then the patient will be better off for it. However, surprisingly few data document whether patients are in fact better off. In this issue, Queale and colleagues1 cast a critical eye on this common procedure and find it wanting. The

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