Hospitalization

Question 1

When should an A1c be performed on hospitalized patient?

Answer 1

• on all PWD IF they do not have A1c within past 4 months

- in those w/ hyper BG >140

Question 2

How should insulin be administered in hospital setting?

Answer 2

Use computerized physician order sets
structured order sets provide computerized advice for glycemic control
The validated protocol should allow for predefined adjustments in insulin dose based on glu fluctuations

Question 3

What DSME should be provided during hospitalization?

Answer 3

• skills needed after d/c
• medication dosing & administration
• glucose monitoring
• ID and treat hypo

Question 4

Why are DM specialist team in hospital helpful?

Answer 4

Reduce LOS
Improve GLU control
Improve overall outcomes
Increase cost savings
Reduce 30 day readmission

Question 5

When to initiate insulin in hospitalized pt?

Answer 5

BG >/= 180

Question 6

Once insulin is started what is the target range in most hosptialized patients?

Answer 6

140-180

Question 7

Who has stricter BG hospital targets?

Answer 7

post surgery, cardiac surgery

110-140

Question 8

How is HYPER defined in hospital?

Answer 8

BG >140

can change their diet or start meds

Question 9

What does A1c >/= 6.5% at admission show?

Answer 9

pre-existing DM

Question 10

Why is tighter glycemic control NOT recommended in hospital?

Answer 10

increase mortality and hypo

Question 11

Who will have higher hospital BG targets >180

Answer 11

terminally ill
severe comorbidities
inpt settings where frequent BG monitoring not possible

Question 12

When should BG be checked bedside?

Answer 12

IF eating- before meals

IF not eating- every 4-6 hours (ex:NPO)

Question 13

How often should pt on insulin drip be monitored?

Answer 13

30 minutes-2 hours

Question 14

CMG is how many minutes delayed compared to finer prick?

Answer 14

15

Question 15

If pt is going to be d/c soon, when should they resume their oral meds

Answer 15

1-2 days before d/c

Question 16

If pt is NPO or eating poorly, what insulin regimen should they be on?

Answer 16

Basal or basal plus bolus

Question 17

If pt is eating well and not critically ill, what insulin should they be on?

Answer 17

Basal, prandial, correction factor

Question 18

WHat is MOST effective method of achieving glycemic targets in hospital

Answer 18

IV insulin

Question 19

If patient is eating, when to inject insulin

Answer 19

immediately before meals

Question 20

If patient is not eating much

Answer 20

give insulin after meal and adjust dose to how much they are

Question 21

What is basal insulin dose based on

Answer 21

body weight

Question 22

All T1DM pts in hospital should get

Answer 22

basal + correction dose

and prandial insulin if they’re eating

Question 23

How to transition from IV insulin to subq

Answer 23

2-4 hours before stopping IV insulin give subq injection

convert to basal insulin at 60-80% daily infusion dose

Question 24

When should pt med regimen be reviewed?

Answer 24

any time BG <70

Question 25

preventable sources of hypo in hospital

Answer 25

• not managing 1st hypo event
• nutrition/insulin mismatch
• sudden reduction in corticosteroid
• reduced oral intake
• emesis
• incorrect timing of rapid or short acting insulin
• interruption of enteral or parenteral feeds
• altered ability to voice s/s hypo

Question 26

Why is hypo in hospital so concerning

Answer 26

can cause morality

can increase risk for another hypo event d/t impaired counterregulatory response

Question 27

Goals of MNT in hospital

Answer 27

adequate kcal
optimize glu control
food preferences
d/c plan for each individual

Question 28

enteral feedings

Answer 28

DM specific formulas are superior
better PP glucose levels
better A1c
insulin response

Question 29

Correction insulin dosing

Answer 29

human insulin- q 6 hours

rapid acting insulin- q 4 hours

Question 30

enteral bolus feeds

Answer 30

1 unit regular human insulin per 10-15 g CHO given subQ before each feeding

Question 31

parenteral feeds

Answer 31

1 unit human insulin for q 10 g dextrose, adjust daily, can add human insulin to the solution but give correction doses subq

Question 32

perioperative care

Answer 32

goal: 80-180
hold metformin day of surgery
give 1/2 NPH dose or 60-80% long acting insulin
hold other oral meds
monitor BG q 4-6 hours while NPO, can give short or rapid acting insulin if needed

Question 33

DKA/HHS goals

Answer 33

resolve hyper
correct acidosis and electrolyte imbalances
treat underlying cause of DKA (sepsis, MI, stroke)
restore circulatory volume

Question 34

treating DKA/HHS

Answer 34

IV insulin is top choice
BUT if not using IV, provide adequate fluids, frequent bedside testing
Do NOT give bicarbonate

Question 35

why are d/c plans helpful

Answer 35

reduce LOS
lower readmission rate
increase pt satisfaction
should start at admission and be updated throuhout

Question 36

When should pt be followed after d/c from hospital?

Answer 36

1 month of d/c OR

if meds were changed/glu control remained inadequate, w/in 1-2 weeks

Question 37

Agency for healthcare research and quality discharge recs:

Answer 37

- medication reconcilliation
structured d/c communication
ID HC provider post d/c
recognize and treat hyper and hypo
refer to outpatient RD
how and when to take meds
sick day mgmt
proper use and disposal of needles/syringes

Question 38

hospital readmission rate in DM is

Answer 38

15-20%; 2x higher than non diabetes

Question 39

what factors increase readmission rate

Answer 39

male
longer LOS 
# of previous hospitalizations
# and severity of complications
lower SES/education status
advanced age

Question 40

Factors that d/c readmission rate

Answer 40

scheduled home health visits
timely outpt f/u
use of transitional care model