Inpatient management of diabetes mellitus

Metchick, Lee N.; Petit, William A.; Inzucchi, Silvio E.

doi:10.1016/s0002-9343(02)01213-5

Cited by 63 publications

(32 citation statements)

References 34 publications

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“…Transition from intravenous to subcutaneous insulin therapy. To maintain effective blood levels of insulin, it is necessary to administer short-or rapid-acting insulin subcutaneously 1-2 h before discontinuation of the intravenous insulin infusion (191,199,(315)(316)(317)(318)(319)). An intermediate or long-acting insulin must be injected 2-3 h before discontinuing the insulin infusion.…”

Section: Subcutaneous Insulin Therapymentioning

confidence: 99%

Management of Diabetes and Hyperglycemia in Hospitals

et al. 2004

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Section: Subcutaneous Insulin Therapymentioning

confidence: 99%

Management of Diabetes and Hyperglycemia in Hospitals

et al. 2004

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“…Since the early 1990s, it has been known (17,18) that sliding-scale insulin protocols in the absence of a basal insulin are associated with wide glycemic variations. Consensus guidelines (4,13,14) and individual experts (15,16) suggest that optimal management of inpatient glycemia should include basal insulin with prandial insulin coverage, rather than sliding scales alone.…”

Section: Research Design Andmentioning

confidence: 99%

Prevalence of Hyper- and Hypoglycemia Among Inpatients With Diabetes

et al. 2007

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“…With Glucommander as the standard, the set of other protocols show little agreement during the first 5 h in the treatment of a patient who is very hyperglycemic and is typical of patients seen clinically (1,3,6,8,(12)(13)(14)(15)(16)(17)(18)(19)(20). This analysis is presented as Fig.…”

Section: Figure 3-the Means and Sds Of The Data From All Glucommandermentioning

confidence: 99%

Glucommander

2005

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OBJECTIVE -Intravenous insulin is now the recommended method of diabetes management in critically ill persons in the hospital. The published methods for administering the insulin are complex and are usually limited to intensive care units with a low patient-to-nurse ratio. RESEARCH DESIGN AND METHODS-A computer-directed algorithm for advice on the delivery of intravenous insulin that is flexible in blood glucose timing and advises insulin dosing in a graduated manner has been developed. This software program, known as the Glucommander, has been used extensively by our group. The data were analyzed for this study.RESULTS -The data from 5,080 intravenous insulin runs over 120,683 h show that blood glucose levels can be safely stabilized in a target range without significant hypoglycemia by nonspecialized nurses working on any unit of a general hospital. The mean glucose level reached Ͻ150 mg/dl in 3 h. Only 0.6% of all glucose values were Ͻ50 mg/dl. The prevalence of hypoglycemia Ͻ40 mg/dl was 2.6% of all runs. No hypoglycemia was severe.CONCLUSIONS -This computer-directed algorithm is a simple, safe, effective, and robust method for maintaining glycemic control. It has been extensively studied and is applicable in a wide variety of conditions. In contrast to other published intravenous insulin protocols, which have been limited to intensive care units, Glucommander can be used in all units of any hospital. Diabetes Care 28:2418 -2423, 2005A large, randomized, controlled trial of patients admitted to a surgical intensive care unit in Leuven, Belgium, and reported by Van den Berghe et al. (1) showed that regulation of blood glucose levels to Ͻ110 mg/dl using an intravenous insulin protocol improved clinical outcomes. In the Leuven study, intensive insulin therapy reduced intensive care unit (ICU) mortality by 34% and also reduced sepsis, the need for dialysis, prolonged ventilator support, and the duration of ICU stay.Strict glycemic control has been demonstrated to be beneficial in other settings as well, with intravenous insulin in preference to the subcutaneous route in many clinical situations, including diabetic ketoacidosis and the nonketotic hyperosmolar state (2), critical care illness (1), myocardial infarction or cardiogenic shock (3-5), and the postoperative period after cardiac surgical procedures (6). Other indications for intravenous insulin infusion therapy include use in patients with diabetes who are receiving nothing by mouth, general perioperative care, total parental nutrition, or high-dose corticosteroid therapy; in patients who have had a stroke; in women during labor and delivery; as a dose-finding strategy in anticipation of initiation of subcutaneous insulin; and in prevention or treatment of infection.Based on the emerging clinical evidence, there are widespread efforts to maintain very strict glycemic control in critically ill patients. However, achieving this goal requires extensive nursing efforts, including frequent bedside capillary glucose monitoring and the implementation of compl...

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Inpatient management of diabetes mellitus

Cited by 63 publications

References 34 publications

Management of Diabetes and Hyperglycemia in Hospitals

Management of Diabetes and Hyperglycemia in Hospitals

Prevalence of Hyper- and Hypoglycemia Among Inpatients With Diabetes

Glucommander

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