Transitional care Flashcards
At what age should a transition plan to an adult health care provider begin for an adolescent
14 years old
Transfer and/or integration into adult centered care should begin between ages 18-21
Why do teens and young adults continue to have the lowest use of technologies such as insulin pumps and CGM?
Hassle of wearing devices and dislike of the devices on their bodies
Upon hospital admission, when should A1c be obtained?
On admit if one has not been performed in the previous 3 months
True or false: during acute illness, insulin therapy is the preferred method to treat hyperglycemia in hospitalized patients?
True
What is the preferred insulin management regimen for a non critically ill patient who is NPO or having poor PO intake?
Basal + bolus correction insulin regimen
Hospitalized patients with good PO intake should follow what type of insulin regimen?
basal, prandial, and correction component
These patients should receive a total date dose of insulin which is divided int 50% basal and 50% bolus components to match their CHO intake. An additional correction dose of insulin should be utilized to cover elevation in the patient’s blood glucose
Why are sliding scale regimens strongly discouraged in the hospital setting?
they provide suboptimal blood glucose
What should patients who present to the hospital on mixed insulin regimens be converted to?
Basal plus bolus regimens
True or false: Insulin use in the hospital means the patient should be transitioned to a home insulin regimen?
False
In a critical care setting, which method is best for achieving glycemic targets?
Continuous insulin infusion
When transitioning from IV insulin drip to SC insulin injections, what % of the 24 hour insulin requirement should the SC dose be?
80%
For example, if TDD is 5 units/hr of rapid acting insulin IV over the previous 24 hours
- 80% of (5 units/hr x 24) =96 units
- Basal dose is 50% of SC TDD: 96 units x 50% =48 units of long acting insulin
- Bolus total dose is the other 50% divided among meals: 48 units/3 meals daily= ~16 units with each meal
What should the starting insulin dose be for patients >70 years and/or GFR <60 mL/min/1.73 m
0.2-0.3 units/kg/day
What should the starting insulin dose be in patients with normal body weight and kidney function who have blood glucose concentrations of 140-200 mg/dL?
0.4 units/kg/day
What should the starting insulin dose be in patients with obesity, a GFR > 60 mL/min/1.73 m and/or a blood glucose concentration of 201-400 mg/dL?
0.5 units/kg/day
When should subq insulin be given in relation to when an insulin drip is planned to be d/c’d?
SC insulin should be given before the drip is d/c’d in order to allow an overlap that takes into consideration the onset of action. The first dose of basal insulin should be given 1-2 hours before the insulin drip is d/c’d
When is outpatient follow up recommended with a provider, endocrinologist, or DCES upon d/c for patients who had hyperglycemia in the hospital?
Within 1 month; patients are more likely to engage with their post hospital f/w appts if they are given a set appointment that is reviewed at or before d/c
What is the definition of clinical inertia?
Failure to initiate or intensify therapy when clinically indicated
For pt’s d/c on oral agents, when should basal insulin be d/c’d?
12-24 hrs before discharge; use bolus insulin when starting oral agents if extra coverage is needed
If BG is checked before exercise a value less than ___ mg/dL requires a modified plan
100 mg/dL
Persons with diabetes should be educated to check their blood glucose how long after exercise?
15 minutes after the exercise session; hypoglycemia can occur 24-48 hour after exercise
