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    Diabetes Management in The Inpt Setting

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    The document discusses guidelines for managing diabetes and hyperglycemia in the inpatient setting. The goal blood glucose range for most patients is 140-180 mg/dL, though some may require tighter or looser control depending on their condition. Patients should be monitored regularly depending on their eating status and treatment regimen. Insulin therapy should be initiated for persistent high blood glucose readings and regimens may include basal, bolus, or continuous infusion depending on the patient's critical status and intake. Oral medications are generally avoided in favor of insulin in the inpatient setting.

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    Diabetes Management in The Inpt Setting

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    api-648401824
    310 views3 pages
    The document discusses guidelines for managing diabetes and hyperglycemia in the inpatient setting. The goal blood glucose range for most patients is 140-180 mg/dL, though some may require tighter or looser control depending on their condition. Patients should be monitored regularly depending on their eating status and treatment regimen. Insulin therapy should be initiated for persistent high blood glucose readings and regimens may include basal, bolus, or continuous infusion depending on the patient's critical status and intake. Oral medications are generally avoided in favor of insulin in the inpatient setting.

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    The document discusses guidelines for managing diabetes and hyperglycemia in the inpatient setting. The goal blood glucose range for most patients is 140-180 mg/dL, though some may require tighter or looser control depending on their condition. Patients should be monitored regularly depending on their eating status and treatment regimen. Insulin therapy should be initiated for persistent high blood glucose readings and regimens may include basal, bolus, or continuous infusion depending on the patient's critical status and intake. Oral medications are generally avoided in favor of insulin in the inpatient setting.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    310 views3 pages

    Diabetes Management in The Inpt Setting

    Uploaded by

    api-648401824
    The document discusses guidelines for managing diabetes and hyperglycemia in the inpatient setting. The goal blood glucose range for most patients is 140-180 mg/dL, though some may require tighter or looser control depending on their condition. Patients should be monitored regularly depending on their eating status and treatment regimen. Insulin therapy should be initiated for persistent high blood glucose readings and regimens may include basal, bolus, or continuous infusion depending on the patient's critical status and intake. Oral medications are generally avoided in favor of insulin in the inpatient setting.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    of 3

    Diabetes Management in the Inpatient Setting

    Compiled by: Madison Heath, PharmD


    Hyperglycemia: Blood glucose of >140mg/mL

    Blood Glucose

    Goal for the majority of critically ill and non-critically ill patients: 140-180 mg/dL

     Lower goal, 110-140 mg/dL: may be acceptable in patients where it can be “achieved without
    significant hypoglycemia”
     Higher goal, 180-250 mg/dL: may be acceptable in patients with severe comorbidities and where
    frequent glucose monitoring, or nurse supervision is possible
     Goal ≥ 250 mg/dL: may be acceptable in terminally ill patients with short life expectancy

    Monitoring

     Patients that are eating: before meals and at bedtime


     Patients that are not eating: every 6 hours
     IV Insulin: Ranges from every 30 minutes – 2 hours
     TPN: every 6 Hours
     Continuous Glucose Monitoring: Currently not approved for inpatient use by FDA
    o Could be changing – Endocrine guidelines recommend CGM use while inpatient for
    insulin dependent, non-critically ill individuals

    Standard Workflow

     Inpatients should have an A1C test if hyperglycemic and/or have diabetes and have not had one
    performed in the past 3 months
    o A1C of ≥ 6.5% - Suggests Diabetes prior to admission
     Insulin should be administered per system protocol

    Inpatient Regimens

     In patients with persistent blood glucose readings ≥ 180 mg/dL on at least 2 occasions, Insulin
    therapy should be initiated
     Non-Critically Ill
    o Poor PO Intake/NPO: Basal Insulin or Basal + Bolus Correction
    o Good Nutritional Intake: Basal, Prandial + Correction Insulin
    *Use of Only Sliding Scale is Discouraged*
     Critically Ill
    o Continuous IV Insulin Infusion is recommended
     BG >230 mg/dL or 2 consecutive readings >180mg/dL

    Diabetes Inpatient Management – M.Heath 8.2022 – 1


     Insulin Dependent Prior to Admission:
    o Convert home insulin to formulary
    o Formulary: Short Acting: Insulin lispro (Humalog), Insulin Regular (Humulin R), Long
    Acting: Insulin glargine (Lantus)
    o After conversion to Lantus – Decrease daily dose by 25-50%

    Medications to Hold

     PO antihyperglycemic medications are avoided in the inpatient setting


    o Sulfonylureas: Hypoglycemia
    o Metformin: Risk of lactic acidosis and ↑ risk of renal failure
    o TZDs: Heart failure concerns
    o DPP-4/GLP-1: Should be used in patients that are eating regularly
    o SGLT2: Avoided in severe illness and prolonged fasting

    https://pro.aace.com/pdfs/diabetes/AACE_2019_Diabetes_Algorithm_03.2021.pdf

    References:

    American Diabetes Association. 9. Pharmacologic Approaches to Glycemic Treatment: Standards of Columbus Regional Health. Hyperglycemia Recognition and Management Policy. Approved
    Medical Care in Diabetes – 2022. Diabetes Care. 2022; 45(Suppl 1): S125-S143. doi: 10.2337/dc22-S009 June 1, 2008. Approved August 12, 2021.

    American Diabetes Association. 16. Diabetes Care in the Hospital: Standards of Medical Care in Korytkowski MT, Muniyappa R, Antinori-Lent K et al. Management of hyperglycemia in
    Diabetes—2022. Diabetes Care. 2022; 45(Suppl 1): S244-S253. doi: 10.2337/dc22-S016 hospitalized adult patients in non-critical care settings: an Endocrine Society clinical practice
    guideline. J Clin Endocrinol Metab. 2022; 107(8): 2101-2128. doi: 10.1210/clinem/ggac278
    Bogun M, Inzucchi SE. Inpatient management of diabetes and hyperglycemia. Clin Ther. 2013;
    35(5):724-733. doi: 10.1016/j.clinthera.2013.04.008 Diabetes Inpatient Management – M.Heath 8.2022 – 2
    References
    American Diabetes Association. 9. Pharmacologic Approaches to Glycemic Treatment: Standards of Medical Care in Diabetes – 2022. Diabetes
    Care. 2022; 45(Suppl 1): S125-S143. doi: 10.2337/dc22-S009

    American Diabetes Association. 16. Diabetes Care in the Hospital: Standards of Medical Care in Diabetes—2022. Diabetes Care. 2022; 45(Suppl
    1): S244-S253. doi: 10.2337/dc22-S016

    Bogun M, Inzucchi SE. Inpatient management of diabetes and hyperglycemia. Clin Ther. 2013; 35(5):724-733. doi:
    10.1016/j.clinthera.2013.04.008

    Columbus Regional Health. Hyperglycemia Recognition and Management Policy. Approved June 1, 2008. Approved August 12, 2021.

    Korytkowski MT, Muniyappa R, Antinori-Lent K et al. Management of hyperglycemia in hospitalized adult patients in non-critical care settings:
    an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2022; 107(8): 2101-2128. doi: 10.1210/clinem/ggac278

    Diabetes Inpatient Management – M.Heath 8.2022 – 3

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