Diabetes Care in the Hospital

Question 1

When should A1c test be performed on a hospitalized pt?

Answer 1

All pts with DM or hyperglycemia (glucose > 140 mg/dL) for pt’s admitted to the hospital if not performed in the prior 3 months

Question 2

When should insulin therapy be started for a hospitalized pt?

Answer 2

For treatment of persistent hyperglycemia > 180; a target of 140-180 mg/dL is rec’d for the majority of critically ill and non critically ill patients. May stringent goals (110-140 mg/dL) may be appropriate for selected pts if they can be achieved w/out significant hypoglycemia

Question 3

What is the definition of hyperglycemia in a hospitalized pt?

Answer 3

> 140 mg/dL

Question 4

When should bedside glucose monitoring be done for hospitalized pt’s who are eating?

Answer 4

Before meals

Question 5

When should glucose be checked for hospitalized pt’s who are not eating?

Answer 5

q 4-6 hours; more frequent testing ranging for q 30 mins-2 hours is standard for safe use of IV insulin

Question 6

True or false: CGM is approved for inpatient use

Answer 6

False; it has NOT been approved by FDA for inpatient use. CGM is also not approved for ICU use.

Question 7

What is the preferred regimen for hospitalized non critically ill patients with poor intake or NPO?

Answer 7

Basal + bolus + bolus correction regimen

Question 8

What is the preferred insulin regimen for noncritically ill hospitalized pt’s with good PO intake?

Answer 8

Basal, prandial, and correction components

Question 9

True or false: Use of only a SSI regimen in the inpatient setting is strongly discouraged

Answer 9

True

Question 10

If oral DM medications are held in the hospital, when should they be resumed?

Answer 10

1-2 days post d/c

Question 11

What insulin regimen may be considered for pt receiving continious EN/PN?

Answer 11

Use of subq rapid or short acting insulin q 4-6 hours

Question 12

True or false: Premixed insulins are suitable for in hospital use

Answer 12

False; not routinely recommended

Question 13

What type of insulin regimen is necessary for all hospitalized pts’ with DM1?

Answer 13

Basal and correction components

Question 14

What should be considered when transitioning pt from IV ot subq regimen?

Answer 14

Pt should receive dose of subq basal insulin 2 hr before IV infusion is d/c’d; dose best calculated on basis of insulin infusion rate during last 6 hrs when stable glycemic goals achieved.

Question 15

SGLT inhibitors should be stopped ___ days before scheduled surgeries

Answer 15

3 (4 days in the case of ertuglifozin)

Question 16

What are some possible causes of iatrogenic hypoglycemia?

Answer 16

Sudden reduction in steriod dose, reduced PO intake, emesis, inappropriate timing of short or rapid acting insulin in relation to meals, reduced infusion rate of IV dextrose, unexpected interruption of EN or PN, delayed/missed BG checks, and alerted ability’s of pt to report symptoms