What is the best way to treat hyperglycemia?

This study compared two different types of insulin regimens as treatment options for hyperglycemia in type 2 diabetes.

One complication of type 2 diabetes mellitus is hyperglycemia, or very high blood glucose (sugar) levels. This can occur for many reasons, including uncontrolled diabetes due to non-compliance (patients not taking their medication as prescribed), infection, or diabetic ketoacidosis. Diabetic ketoacidosis is a complication that can develop when there is not enough insulin (the hormone used to break down glucose) to help glucose enter the cells of the body. Cells need glucose for energy; if the cells do not get enough glucose they begin to break down fat for energy. The process of breaking down fat for energy can lead to a toxic build-up of ketones (acids) in the blood.

Despite the seriousness of hyperglycemia, the best way to treat the condition is not clear. One treatment option is the sliding-scale insulin regimen, in which the insulin dose given is based on the current blood glucose level. However, this method has been shown by some to be less effective at controlling hyperglycemia than a basal-bolus insulin regimen (a combination of long-acting and short-acting insulin). 

This study compared the use of sliding-scale insulin to that of basal-bolus insulin in patients with severe hyperglycemia. The authors examined the records of 202 patients with type 2 diabetes who were admitted to hospital at least once over a 5-year period for hyperglycemia.

The average blood glucose level was 24.4 mmol/L at the time of hospital admission. The sliding-scale insulin regimen was used in 53% of patients, and the basal-bolus insulin regimen was used in 47% of patients.

Patients treated with basal-bolus insulin attained a significantly lower blood glucose level (12.3 mmol/L) compared to those treated with sliding-scale insulin (12.8 mmol/L). Fasting blood glucose (glucose levels following a long period without food or drink) was also significantly lower following basal-bolus insulin (10.8 mmol/L) than sliding-scale insulin (11.6 mmol/L).

This study concluded that the basal-bolus insulin regimen resulted in lower blood glucose levels than the sliding-scale insulin regimen in patients with hyperglycemia.