What is the preferred approach for subcutaneous insulin administration in hospitalized adults with diabetes mellitus?

• A. Bolus insulin therapy
• B. Basal-bolus insulin therapy
• C. Sliding-scale insulin therapy
• D. Basal insulin therapy

Answer: (B)

Basal-bolus therapy is preferred because it mimics normal insulin use by providing a steady background level of insulin plus targeted doses to cover meals and correct high glucose. The basal component maintains baseline insulin to control fasting glucose, while the bolus (rapid-acting) component is given at mealtimes to match carbohydrate intake and prevent postprandial spikes. This approach gives you flexibility to adjust for varying meal content and illness-related glucose changes, delivering tighter glycemic control and fewer large swings.

Relying on sliding-scale insulin alone is reactive; it treats hyperglycemia after it appears and often results in wider glucose fluctuations. Giving bolus insulin without a basal level leaves fasting glucose inadequately controlled, and using basal insulin alone may not adequately address post-meal rises. In hospitalized patients, where intake can be unpredictable and metabolic stress is common, basal-bolus therapy provides the most physiologic and adaptable framework for maintaining stable glucose levels, with adjustments guided by frequent glucose monitoring.