In Hospital Management Flashcards
Why should an A1C be drawn in all patients with hyperglycemia whether diabetic or not, (if one hasn’t been done in last 2-3 months) even if you already have a FBG drawn and it is above 7.8
Diabetics: A1C can help identify who Would benefit from efforts to improve glycemic control.
New hyperglycemia; A1C helps to differentiate patients with previously undiagnosed diabetes from those who have stress induced hyperglycemia.
Why is hyperglycemia common in hospitalized patients?
Even in patients without diabetes, hyperglycemia is common as acute illness caused an increase in stress hormones. As well, acute illness sometimes means medications such as glucocorticoids may be being used.
In hospital hyperglycemia is defined as any glucose value over….
7.8mmol/l
Acute hyperglycemia in the intensive care setting is not uncommon and often caused by: 2
Meds given in ICU
Release of stress induced counter-regulatory hormones.
What is the preferred method for glycemic control in hospitalized patients?
Insulin. Basal, bolus and supplemental when needed. SC. Though IV may be approprite for critcally ill and for DKA and HHS
Do you withhold insulin in hospital if a patient isn’t eating?
You always give basal. You can lower or withhold bolus if patient isn’t eating.
If a type 2 diabetic in hospital needs insulin for the first time, how do you initiate?
Sliding scale is now considered ineffective.
Basal bolus is superior. Start 0.4 to 0.5 units per kg. Divided with 40-50% given as basal and remaining divided up in three doses for each meal. Supplemental doses are given if BG above target.
*Patients BG measurements should be reviewed daily and insulin adjusted accordingly.
What is the Role of oral antihyperglycemics in hospital?
No outcome studies. In general home meds can be continued as long as theres no contraindications. (Irregular eating, contrast dye, renal or hepatic failure). In these patients, po drugs should be stopped and basal bolus insulin started.
How is glycemic control achieved in patients who are on parenteral nutrition?
Initially, regular insulin is added at 80% of TDD Insulin to the PN bag. Or can be given by separate infusion. Supplemental sc doses given as needed. This is to determine TDD.
If PN is interrupted, sc injection should be given to prevent DKA.
If TDD is determined, since PN is continuous, the TDD of insulin can be given as qd glargine or bid Detemir.
However, if patients are receiving bolus feeds then basal bolus regimen should be used.
What is thd recommended monitoring for patients with no history of diabetes receiving high dose cortisone?
Glycemic monitoring for at least 48 hours. Managed with insulin if needed. Basal bolus. Adjust down when steroids are being tapered off.
Is it recommended that patients continue insulin pump ie: CSII therapy when hospitalized?
Can continue if they can demonstrate physical and mental competency and have all their supplies.
**tend to have less hypo than being managed by admitting clinician!
If they can’t manage then it should be d/c and sc regimen or infusion given.
What hospital patient population should you be cautios about using capillary BGM?
Critically ill. As they may have poor perfusion. Use venous or arterial
Glycemic targets for:
Non-critically Ill
Critically ill
Other: CABG intraopertively Peri operatively othet surgery ACS Labour and delivery
Non critical
Pre-P 5-8
Post. < 10.
Random <10
Critically ill 6-10
CABG intraopertively 5.5-11 *using IV insulin rather than sc
Peri operatively othet surgery 5-10
ACS. 7-10
Labour and delivery. 4-7
On admision, at what A1C woukd you initiate CBG monitoring for a patient?
> = 6.5
What frequency of CBG bedside monitoring for the follwing patients?
Those who are eating
NPO or continuous enteral
Critically illl or on IV insulin
Normal: BEFORE meals and hs
NPO/enteral. Every 4-6hr
ICU:/IV insulin every 1-2 hours
