In-Patient Diabetes Management

Question 1

glucoses less than what are associated with the highest incidence of complications?

Answer 1

less than 70

Question 2

glucoses less than 70 are associated with what complications?

Answer 2

arrhythmia

delirium

aspiration events

falls

Question 3

hypoglycemia is most often seen with what 3 things?

Answer 3

sulfonylureas

sliding scales

intesnive insulin therapy

Question 4

acceptable glucoe ranges for NON-criticaly ill hospitalized patients:

pre-meal?

fasting?

average random glucose?

Answer 4

pre-meal < 140

fasting no lower than 90

average random glucose < 180

Question 5

how can we avoid the common mistakes relating to sulfonylureas and sliding scale?

Answer 5

sulfonylureas- hold for any chance of poor PO intake

sliding scale- continue close monitoring particularly peri-operatively unpredictable PO intact

Question 6

what type is insulin is used in the sliding scalre and can be more safely administered without fear of precipitating hypoglycemia?

Answer 6

short-acting insulin

Question 7

management for hypoglycemia

Answer 7

prevent it!

asymptomatic or mildly symptomatic patients who can take PO → 20g oral glucose (glucose tabs/gel, juice/milk, snack/meal)

one amp of D50 followed by PO intake IF safe to take PO

Question 8

according to the American Diabetes Association, what should we keep the glucose level under to avoid hyperglycemia?

Answer 8

keep it < 180

Question 9

3 effects of hyperglycemia

Answer 9

1. increase risk of infection (immune system & neutrophil function decreased)
2. volume depletion (dehydration) from osmotic diuresis (renal failure & severe electrolyte disturbances)
3. caloric & protein loss (poor healing/rehabilitation & edema)

Question 10

management for hyperglycemia

Answer 10

ADA diet

PO meds - often had to be held

insulin - sliding scale

Question 11

sliding scale

1 unit for?

2 units for?

3 units for?

4 units for?

call pysican for?

Answer 11

1 unit → BS 200-250

2 units → BS 251-300

3 units → BS 301-350

4 units → BS 351-400

call physican for BS > 401

Question 12

what is a common insulin regimen for hospitalized patients

Answer 12

basal insulin plus scheduled short acting plus sliding scale

Question 13

how is the total daily insulin requirement calculated?

Answer 13

0.5-1 unit/kg

Question 14

how is the total daily insulin usually split in a single day?

Answer 14

50% basal insulin usually given in one dose QHS

50% in short acting insulin- short acting insulin dividing over the day (3x)

Question 15

what are some of the logistical barriers to consider prior to discharging a patient with DM from the hospital?

Answer 15

insurances- will they pay for it?

local pharmaceutical access- do they have it in stock?

equipment- test strips, glucometer, syringes

sustainability- patient self management

Question 16

what do we do if the patient has Type 1 diabetes?

Answer 16

stop whatever we are doing (within reason)

ensure they have a steady source of insulin going into their body (even if NPO)