NAPLEX (North American Pharmacist Licensure Examination) Practice Exam

What approach is strongly discouraged for inpatient glucose control?

1. Use of sliding scale insulin alone

2. Basal-bolus regimen

3. Proactive approach with basal and bolus insulin

4. Oral diabetes medications

The correct answer is: Use of sliding scale insulin alone

Using a sliding scale insulin alone is strongly discouraged for inpatient glucose control because it does not provide basal insulin coverage or address the underlying insulin requirements throughout the day. Sliding scale insulin is reactive and may lead to wide fluctuations in blood glucose levels, resulting in poor glycemic control and an increased risk of hypoglycemia. Basal-bolus regimens are preferred for inpatient glucose control as they mimic the physiological secretion of insulin in the body, providing both basal insulin to cover fasting glucose levels and prandial (bolus) insulin to cover postprandial increases in blood sugar. This approach allows for more individualized and precise insulin dosing, resulting in better glycemic control. Using an oral diabetes medication for inpatient glucose control is generally not recommended, as these medications may not act quickly enough to address acute changes in blood glucose levels seen in hospitalized patients. Additionally, some oral medications may increase the risk of hypoglycemia in the inpatient setting. Therefore, a proactive approach with basal and bolus insulin, such as a basal-bolus regimen, is the preferred method for inpatient glucose control over the use of sliding scale insulin alone.