Juicebox Podcast: Type 1 Diabetes

Episode #1763: Defining Diabetes—Sliding Scale
Host: Scott Benner
Guest: Jenny (long-time diabetes educator and person with type 1 diabetes)
Date: February 7, 2026

Episode Overview

In this episode, Scott and Jenny revisit the "Defining Diabetes" series to break down the term "sliding scale," a historically common method for insulin management in Type 1 Diabetes. Their discussion blends personal experience with practical explanations, comparing past and present approaches, and examining why sliding scale is still in use today despite improvements in diabetes management technologies.

Key Discussion Points and Insights

1. What Is "Sliding Scale" Insulin Dosing? (01:39, 02:41, 06:17)

• Definition:
  A sliding scale assigns fixed insulin doses to specific blood glucose ranges and fixed carbohydrate servings at set meal times. Adjustment for high blood sugars occurs by adding set units of insulin based on the degree of elevation.

  • Jenny explains:

    "You get a set amount of insulin for a meal. Breakfast is three units, lunch is five units, dinner is six units. That’s your dose for the food… If your blood sugar sliding scale corrective was also another math part to add to that. If your blood sugar is here to here, add one unit. If blood sugar is here to here, add two units or three units." (02:41)

  • Scott summarizes:

    "Put it real black and white for me… I’m at the doctor and they’re just gonna say, hey, put in this much insulin at this time, eat at this time, eat this much food. If your blood sugar is 150 to 199, I want you to do this much. If it’s 200 to 250, I want you to do a little this much. That’s it. That’s a slide, and that’s it." (08:48)

• Background:
  Sliding scale was the standard before rapid-acting insulin analogs and intensive management techniques (e.g., carb counting and algorithmic pumps).

2. Personal Experience with Sliding Scale (01:39, 03:50, 04:03)

• Jenny recounts:

  • She used sliding scale until rapid-acting insulins like Humalog became available when she was in college.

  • Her regimen required all food to be weighed and measured; her mother played a significant role in managing her meals.

    "My parents, especially my mom was kind of the controller of the food… everything was weighed and measured… It made it workable in my brain at that age." (04:03)

• Physical activity:
  Jenny, as a child and teen, noticed that despite all the measuring, activities like dance and biking with her dad added unpredictability—even though she followed instructions closely.

  "With those variables, I saw that if I just stuck with the schedule that I was given, it worked out pretty well. Now, what happened in between finger sticks, I don't know. There was no CGM to say, gosh, this dose really is the right one for you." (04:03)

3. Sliding Scale Today: Why Is It Still Used? (05:20, 06:17)

• Access Disparities:
  While many have transitioned to more precise management methods (pumps, CGMs, carb counting), sliding scale persists—often due to limited access to technology or advanced diabetes education.

  "It’s access to technology. It’s access to a clinical service that has encouraged you to be able to be better because they’re providing you the ability to have technology. And many people don’t have that. So sliding scale is what it is." (05:20)

• Variations in guidance:
  Jenny notes that not everyone receives detailed education about matching food intake to insulin; some are told simply to take a specific dose for a meal, with little carbohydrate guidance.

  "With some sliding scale people that I’ve worked with, they’re not even given as much detail as I was… There's not as much detailed 'your meal has to consist of this much food because we're expecting three units to cover your food.'" (05:20)

• Sliding scale on modern technology:
  Some people use sliding scale principles with insulin pumps, setting manual insulin doses or using pumps for set corrections instead of full carb counting.

  "I would even say that there are some people that might be using their pump as sliding scale instead of carb counting… They may actually just be dialing in a manual dose of insulin." (06:37)

4. Precision, Challenges, and Lifestyle (07:34, 08:20)

• Pros and cons:
  Even with meticulous management, sliding scale's lack of flexibility can result in "yo-yoing" blood sugars unless people are exceptionally careful.

  "There’s a lot of yo-yoing that goes on… Unless they’re willing to get… You know, I have a couple of friends who use MDI and do very well with it, but theirs is a precision." (07:34)

• Modern MDI users:
  Some do well by custom-tailoring fixed doses to their habitual foods, not by calculating carbs every time.

  "Most of them have also found that their most common foods, they’ve just figured out the dose for it. They don’t necessarily have an insulin-to-carb ratio." (07:34)

5. Technological Evolution and Limitations (09:34, 09:43)

• Old insulins and methods still in use:
  Some regions or economically disadvantaged groups continue to use regular and NPH insulins, requiring "very old school" sliding scale management.

  "Are there places in the world where people are still using, like, regular and NPH?" – Scott
  "Oh, absolutely… Yes." – Jenny (09:43-09:44)

• Lifestyle adjustments:
  In the past, the unpredictability of older insulins meant fixed snack times and meal schedules, rigid adherence, and individual improvisation for activities.

  "With even the intermediate acting cloudy insulin… I had a very different snack in the afternoon depending on whether I was headed to a sport after school or not." (10:30)

Notable Quotes and Memorable Moments

• On how sliding scale feels today:

  "It’s like hearing somebody uses a fax machine. You’re like, what? … But is that still pretty common?" – Scott (04:54)

• On food aversions:

  "I’ve never had cottage cheese in my life." – Scott
  "You’ve never had cottage cheese?" – Jenny
  "And as you’re talking about it, it makes me feel icky. I just wanted to say that." – Scott (08:20-08:27)

• On adaptability:

  "You kind of figure out as you go." – Scott (11:06)

Timestamps for Key Segments

• [01:39-03:50] — Jenny’s early experiences and shifting away from sliding scale
• [04:03-04:54] — How meticulous food management worked with sliding scale
• [05:20-06:17] — Why sliding scale is still in use; access disparities
• [06:37-07:34] — Sliding scale applied to modern tech (CGMs & pumps)
• [07:34-08:20] — The challenge of achieving tight control with sliding scale
• [08:48-09:14] — Sliding scale broken down in “black and white” terms
• [09:43-10:30] — Continued use of old insulins in some populations
• [10:30-11:08] — Adjustments for sports, snacks, and unpredictability

Tone and Style

The conversation is open, conversational, and honest—balancing Jenny’s educational expertise and lived experience with Scott’s approachable curiosity, including playful detours about food preferences and personal anecdotes.

Takeaways

• Sliding scale insulin dosing, while outdated by current standards, is still widely used due to gaps in access to technology or diabetes education.
• Managing diabetes with sliding scale can work for some—especially with strict routines—but lacks the precision and flexibility of modern methods like carb counting and algorithmic pumping.
• Knowledge, resources, and technology access are crucial for advancing beyond sliding scale to individualized and dynamic diabetes care.