Which insulin strategy is least favored in hospitalized patients?

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

Answer: (C)

Inpatient glucose management aims to mimic normal insulin patterns with steady background coverage and meal-related tweaks. Sliding-scale insulin therapy is least favored because it is reactive rather than proactive. It waits for glucose to rise before dosing, so hyperglycemia can occur for hours and there is no basal insulin to cover fasting or overnight needs. This approach yields greater glucose variability and higher risk of both hyperglycemia and hypoglycemia, and it often increases nursing workload with frequent dose adjustments.

In contrast, basal-bolus therapy combines a background (basal) insulin to suppress hepatic glucose production with rapid-acting insulin at meals to control post-meal rises, providing more stable and predictable control. Basal insulin alone may help fasting glucose but won’t adequately address postprandial spikes, while bolus insulin without a basal component leaves fasting levels unchecked. Therefore, the strategy that uses both basal and mealtime insulin is preferred, making sliding-scale insulin the least favored option.