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The practice of discontinuing oral diabetes medications and/or insulin therapy and starting sliding scale insulin (SSI) results in undesirable levels of hypoglycemia and hyperglycemia.79,80 The SSI regimen, although straightforward and easy to use, is faced with several challenges that include inadequate coverage of glycemic excursions and insulin stacking.81 The safety of scheduled subcuntaneous (SC) basal bolus insulin has been demonstrated in different studies in hospitalized patients with type 2 diabetes.82,83 In one study that included insulin naive patients with type 2 diabetes, glycemic control was achieved more effectively with basal bolus insulin than with SSI.83 Mean glucose levels of tiospirone as a BG 13.3 mmol/L (>240 mg/dL). A second study compared two different basal selleck compound bolus insulin regimens (detemir plus aspart vs. NPH plus regular insulin) in hospitalized patients with type 2 diabetes, some of whom were receiving insulin therapy prior to hospitalization. There were no significant differences in the levels of glycemic control or in the frequency of hypoglycemia. The recent Rabbit Surgery trial, a randomized multicenter study, compared http://www.selleckchem.com/products/Docetaxel(Taxotere).html the efficacy and safety of improving glycemic control with a basal bolus regimen compared to sliding scale regular insulin (SSI) in 211 patients with type 2 diabetes undergoing general surgery.84 Study outcomes included differences in daily BG levels and a composite of postoperative complications including wound infection, pneumonia, respiratory failure, acute renal failure, and bacteremia. Patients were randomized to receive basal bolus regimen with glargine and glulisine at a starting dose of 0.5 unit/kg/day or SSI given 4 times/day. The basal bolus regimen resulted in significant improvement in glycemic control and reduced the frequency of the composite outcome. The results of the Rabbit Surgery trial indicate that treatment with glargine once daily plus rapid-acting insulin before meals improves glycemic control and reduces hospital complications compared to SSI in general surgery patients with type 2 diabetes. Using these studies as a guide, the AACE/ADA outlines that insulin can be used to maintain random BG levels