PALTmed recently published a list of 20 things physicians and patients should question in post-acute and long-term care—and one entry stood out for anyone involved in long-term diabetes management. Many of the recommendations relate to what’s called “clinical momentum,” a concept that challenges the automatic use of interventions like percutaneous feeding tubes, antipsychotics for dementia-related behaviors, and lipid-lowering drugs in older adults nearing end-of-life.

One recommendation? Stop using sliding scale insulin (SSI) for long-term diabetes management. It’s a reactive approach, addressing hyperglycemia after it happens instead of preventing it. Reading that made my heart (and fingers) happy! According to the consensus, there’s solid evidence that SSI doesn’t meet the body’s physiologic insulin needs and isn’t efficient in the long-term care setting for medically stable residents. It often leads to more frequent glucose checks and injections, more discomfort for the resident, and more burden on nursing staff. Plus, if a resident’s food intake is inconsistent, SSI can lead to major glucose swings—or even hypoglycemia.

Think about how often we’re doing pre-meal and bedtime glucose checks for residents in their 90s. Maybe it’s time to pause and reassess. Consider discussing the Choosing Wisely recommendations from PALTmed with your medical director and attending physicians. Run a list of residents with a diabetes diagnosis and bring it to your next QAPI meeting. Not every resident will be a candidate for eliminating SSI—but isn’t it worth the conversation?

If you can improve just one resident’s quality of life, that’s progress.

Stay well and stay informed!