Management of hyperglycemia in hospitalized patients

Question 1

Principles

Answer 1

Do not give rapid/short acting insulin without basal insulin

Multiple daily injection regime in all non-crtically ill patients with hyperglycemia

Question 2

T1DM

Answer 2

Never with hold basal insulin

Unwell and not eating: IV insulin and glucose infusion

Question 3

Multiple daily injection regime

Answer 3

Basal: long acting OD or BD
Blood glucose before meals with rapid acting before meals (or after if variable/vomiting)
Supplement insulin if hyperglycemic before meals

Question 4

Calculating multiple daily injection regimen doses: already using insulin

Answer 4

Total usual insulin dose
Divide into 50:50
50% basal
50% bolus given in divided doses before meal

Question 5

Calculating multiple daily injection regimen doses: Not on insulin

Answer 5

Basal: Long acting 0.2 units/kg Max 30 OD
Bolus: Rapid acting 0.2 units/kg max 30 in divided doses before meals

Question 6

Metformin

Answer 6

With hold if unwell and risk of renal impairement or likely to need radiocontrast

Question 7

SGLT2 inhibitors

Answer 7

Risk of GU infection
Dehydration
DKA
With hold in unwell patients

Question 8

Sulphonylureas

Answer 8

Risk of hypoglyceamia if not eating

Question 9

GLP1 receptor agonists

Answer 9

Exacerbate N+V

Anorexia

Question 10

DPP4 inhibitors

Answer 10

Exacerbate heart failure (saxagliptin, alogliptin)

Question 11

Thiazolidinediones

Answer 11

Fluid retention

Exacerbate heart failure

Question 12

Acarbose

Answer 12

GI upset

Give glucose not sucrose in hypoglycemia