Hyperglycemia in the Hospital

Abstract

In Brief This article reviews the use of subcutaneous insulin for hospitalized patients. Topics include the rationale for using insulin;scheduled insulin therapy to cover basal and nutritional needs; correction therapy; dose determination; establishment of timing of insulin action appropriate to the pattern of carbohydrate exposure; education of caregivers;and the design of hospital systems that will promote quality and help staff to manage complexity.

Protocol for blood glucose control during enteral nutrition induction in patients with diabetes mellitus

“…For this reason the daily insulin requirement must be considered as the sum of two components, basal and nutritional, which can be calculated theoretically in order to plan a scheduled insulinisation. [6,7]. Tables 2 and 3 show the basal need subdivided by weight with respect to patients with diabetes mellitus types 1 and 2.…”

“…When an acceptable glycaemic level is reached (111-140 mg/dl), a "scheduled insulin therapy" can be followed to cover both basal and nutritional needs [6,7]. For this reason the daily insulin requirement must be considered as the sum of two components, basal and nutritional, which can be calculated theoretically in order to plan a scheduled insulinisation.…”

Practical aspects of intensive insulinization in the intensive care unit

“…In this section, we will not repeat generalized arguments against sliding-scale monotherapy [58][59][60][61] or strategies for transitioning from intravenous to subcutaneous insulin, which have been treated elsewhere [40,54,[62][63][64][65][66][67][68][69].…”

Prevention of Hospital Hypoglycemia by Algorithm Design: A Programming Pathway for Electronic Order Entry

“…Timing of testing, insulin, and meals may be coordinated by justaposition of related orders on a paper order set. A lynchpin of successful order writing is the coordination of the patterns of glucose monitoring and insulin administration with carbohydrate exposure (Bellam and Braithwaite, 2010;Braithwaite et al, 2007;Campbell et al, 2004;Thompson et al, 2005). If an order set is well designed, by checking boxes and entering numbers the prescriber creates orders that are familiar to and readily interpreted by pharmacy and nursing staff.…”