Thanks for clearing that up, i am with Mike and bolus based on current conditions and for the carbs i am about to eat. I thought throughout this thread that that was the sliding scale.
I think a key question is, how did your doctor come up with the scale they gave you? Unless they did a pretty good study, what you got was just an educated guess. I have modified my pump settings several times based on current lifestyle event such as average exercise or week, eating habit changes, etc. I think that is required to maintain good control.
For what itâs worth, the old school sliding scales didnât have carb counts because the carb counting was figured into the dietâback then, I was supposed to eat a set amount of carbs at each meal and snack (1 diabetic âbreadâ exchange = 15 grams of carbs). Sliding scales should work in theory if you do that; the problem is few of us can or want to do the exact same thing every day, so having a more flexible system that allows for both variability in a correction factor (similar to the old sliding scales) and a carb ratio (the new aspect) is much more realistic for most people, including myself.
That said, correction factors and sliding scales both tend to make the error of assuming a linear relationship between blood sugar and correction doses. I know for me, once I get pretty high, the curve gets significantly steeper, and I start have to tacking on extra units. I think thatâs fairly common.
@cardamom - I totally agree! If we ate a set amount every meal, that would work! But who really does that? Not meâŚ
Sliding scale insulin therapy is sometimes called âConventional Insulin Therapy.â The other conventional regime is an insulin âmixâ of rapid and long acting, often NPH and R. These are still used and some hospitals still routinely use a sliding scale as it is a very conservative treatment. The problem with sliding scale is that it is a âlaggingâ treatment that essentially âbeats downâ highs hours after they occur. But an important advantage is that if a sliding scale or fixed mix regime works it can often simplify your regime. Think about it, how many of us on insulin would love to be able to take 2 or 3 fixed doses of insulin and not necessarily have to worry about testing our blood sugars all the time, counting carbs and doing the math.
That being said, after the DCCT trial it became pretty well accepted that âIntensive Insulin Therapyâ was a more effective treatment and could markedly reduce complications, particularly for those with poorly controlled diabetes. That being said, millions of people still use conventional insulin therapy and if it works well for you it is simpler and can be much cheaper (particularly if you can use NPH and R).
And it is good to know that if you ever become unhappy with your diabetes control you can step up your game with intensive insulin therapy.
Speaking of the âgood old daysâ, I remember when my dad checked his BG by peeing on a stick and matching the color to a chart. Iâm guessing that the imprecision contributed to the stroke he had. The early glucose meters required prodigious amounts of blood, and there was a time limit in which to administer it. I recall my dadâs frustration at not being able to get the blood on the strip in time and having to start over. Now, I have a pump and a CGM. My nurse practitioner also knows more about diabetes care than probably 90% of doctors. She has been fantastic. Iâm very fortunate. Sheâll prescribe just about anything I want to try, like Afrezza, which did not work for me.
@Gallen: I eat 10-20 carbs a day, sometimes less. No dawn phenomenon anymore.
If I eat more than 70+/day, it takes me days to get control back.
And as a followup, just had my semi-annual A1C and it went down from 6.8 to 6.3. Iâm making progress in spite of my dim-wittedness. 
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Great job!