Management Of hyperglycemia in the non-intensive care patient: featuring subcutaneous insulin protocols

Pichardo-Lowden, Ariana; Fan, Chris; Gabbay, Robert A.

doi:10.4158/ep10220.ra

Cited by 42 publications

(39 citation statements)

References 59 publications

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“…For patients receiving continuous peripheral or central parenteral nutrition, regular insulin may be added to the solution, particularly if .20 units of correctional insulin have been required in the past 24 h. A starting dose of 1 unit of human regular insulin for every 10 g dextrose has been recommended (57), to be adjusted daily in the solution. Correctional insulin should be administered subcutaneously.…”

Section: Standards For Special Situations Enteral/parenteral Feedingsmentioning

confidence: 99%

14. Diabetes Care in the Hospital: Standards of Medical Care in Diabetes—2018

2017

Diabetes Care

157

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The American Diabetes Association (ADA) “Standards of Medical Care in Diabetes” includes ADA’s current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA’s clinical practice recommendations, please refer to the Standards of Care Introduction. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.

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Section: Standards For Special Situations Enteral/parenteral Feedingsmentioning

confidence: 99%

14. Diabetes Care in the Hospital: Standards of Medical Care in Diabetes—2018

2017

Diabetes Care

157

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“…This multispecialty approach can be effective only if all members of the medical team have access to a patient's day-to-day treatment notes, laboratory data, and nursing updates. See Table 2 for examples of common barriers to improving and maintaining optimal blood glucose control in hospitalized patients [10]. Electronic medical records (EMRs) can certainly facilitate these goals, and communications protocols are essential.…”

Section: Inpatient Diabetes Managementmentioning

confidence: 99%

“…Thus, recommendations must be based on clinical experience and judgment. However, for patients who receive insulin, premeal blood Table 2 Common barriers to improving and maintaining optimal blood glucose control in hospitalized patients [10] The standards of care also state that for noncritically ill patients, scheduled subcutaneous insulin with basal, nutritional (otherwise known as meal time or prandial), and correction components is preferred for achieving and maintaining glucose control. Moreover, glucose monitoring should be standard operating procedure in all nondiabetic patients who receive treatment that carries high risk for hyperglycemia, including high-dose glucocorticoid therapy, enteral or parenteral nutrition, or medications such as octreotide or immunosuppressive agents.…”

Section: Blood Glucose Goals Vary According To Whether a Patient Is Cmentioning

confidence: 99%

“…Basal-bolus insulin therapy allows for dosage flexibility and is well suited for patients with varied food intake or irregular meal patterns. An added advantage to basal-bolus insulin therapy is that a healthcare provider can adjust insulin doses on the basis of monitored blood glucose levels at each meal [10].…”

Section: Determining Insulin Strategiesmentioning

confidence: 99%

“…If premeal glucose is low, the dose can be decreased. Hospital staff adjust basal and prandial insulins independently to achieve target A1C levels and blood glucose levels [10].…”

Section: Determining Insulin Strategiesmentioning

confidence: 99%

See 2 more Smart Citations

Hospital-Based Management of Diabetes Mellitus

Ford

Brogan

Volturo

et al. 2014

Curr Emerg Hosp Med Rep

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Patients with insulin-dependent diabetes mellitus or noninsulin-dependent diabetes mellitus are frequently admitted to a hospital, usually for primary conditions other than diabetes. In addition to endorsing tight glycemic control in critical care units, current standards of care recommend treatment targets similar to those of outpatients for noncritically ill patients in hospital. Given the current prevalence of diabetes (DM), how best to address hyperglycemia in the Emergency Department (ED) is an increasingly relevant issue in which the principal goals are to minimize disruption of the metabolic state and achieve a stable glycemic balance as promptly as possible. Transition of care from the ED to an inpatient service can result in gaps in comprehensive care, particularly in patients with DM who may have other serious comorbidities. In critically ill patients, insulin therapy should be initiated for treatment of persistent hyperglycemia, starting at [180 mg/dL (10 mmol/ L). After insulin therapy has been started, the standard of care recommends a random glucose range of 140-180 mg/dL (7.8-10 mmol/L) for the majority of hospitalized patients. The traditional model of care among hospital-based physicians has been to treat the diabetic patient with a regular insulin on a sliding scale. Current evidence suggests that while this approach is straightforward, it may not be the best for patient care. Patients who present to the ED or are hospitalized often require an insulin regimen that can change rapidly as their condition changes. A basal/bolus insulin regimen fulfills those criteria and mimics a normal insulin profile.Keywords Diabetes related heart disease Á Insulindependent diabetes mellitus Á Emergency and hospital medicine Á Cardiovascular health Á Noninsulin-dependent diabetes mellitus Á Hospital-based management of DM

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Association of Postoperative Hyperglycemia With Outcomes Among Patients With Complex Ventral Hernia Repair

et al. 2015

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IMPORTANCE Patients with medically complex conditions undergoing repair of large or recurrent hernia of the abdominal wall are at risk for early postoperative hyperglycemia, which may serve as an early warning for delays in recovery and for adverse outcomes. OBJECTIVE To evaluate postoperative serum glucose level as a predictor of outcome after open ventral hernia repair in patients with major medical comorbidities. DESIGN, SETTING, AND PARTICIPANTS We performed a retrospective medical record review of 172 consecutive patients who underwent open ventral hernia repair at Penn State Milton S. Hershey Medical Center, an academic tertiary referral center, from May 1, 2011, through November 30, 2013. We initially identified patients by medical complexity and repair requiring a length of stay of longer than 1 day. MAIN OUTCOMES AND MEASURES Postoperative recovery variables, including time to the first solid meal, length of stay, total costs of hospitalization, and surgical site occurrence. RESULTS Postoperative serum glucose values were available for 136 patients (79.1%), with 130 (95.6%) obtained within 48 hours of surgery. Among these patients, Ventral Hernia Working Group grade distributions included 8 patients with grade 1, 79 with grade 2, 41 with grade 3, and 8 with grade 4. Fifty-four patients (39.7%) had a postoperative glucose level of at least 140 mg/dL, and 69 patients (50.7%) required insulin administration. Both outcomes were associated with delays in the interval to the first solid meal (glucose level, Ն140 vs <140 mg/dL: mean [SD] delay, 6.4 [5.3] vs 5.6 [8.2] days; P = .01; Ն2 insulin events vs <2: 6.5 [5.5] vs 5.4 [8.4] days; P = .02); increased length of stay (glucose level, Ն140 vs <140 mg/dL: mean [SD], 8.0 [6.0] vs 6.9 [8.2] days; P = .008; Ն2 insulin events vs <2: 8.3 [6.1] vs 6.5 [8.4] days; P < .001); increased costs of hospitalization (glucose level, Ն140 vs <140 mg/dL: mean [SD], $31 307 [$20 875] vs $22 508 [$22 531]; P < .001; Ն2 insulin events vs <2: $31 943 [$22 224] vs $20 651 [$20 917]; P < .001); and possibly increased likelihood of surgical site occurrence (glucose level, Ն140 vs <140 mg/dL: 37.5% [21 of 56 patients] vs 22.5% [18 of 80 patients]; P = .06; Ն2 insulin events vs <2: 36.4% [24 of 66 patients] vs 21.4% [15 of 70 patients]; P = .06). Not all patients with diabetes mellitus developed postoperative hyperglycemia or needed more intense insulin therapy; however, 46.4% of the patients who developed postoperative hyperglycemia were not previously known to have diabetes mellitus, although most had at least 1 clinical risk factor for a prediabetic condition. CONCLUSIONS AND RELEVANCE Postoperative hyperglycemia was associated with outcomes in patients in this study who underwent complex ventral hernia repair and may serve as a suitable target for screening, benchmarking, and intervention in patient groups with major comorbidities.

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Management Of hyperglycemia in the non-intensive care patient: featuring subcutaneous insulin protocols

Cited by 42 publications

References 59 publications

14. Diabetes Care in the Hospital: Standards of Medical Care in Diabetes—2018

14. Diabetes Care in the Hospital: Standards of Medical Care in Diabetes—2018

Hospital-Based Management of Diabetes Mellitus

Association of Postoperative Hyperglycemia With Outcomes Among Patients With Complex Ventral Hernia Repair

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