In hospital Management of Diabetes

Question 1

Improving glycemic control improves patient outcomes
and reduces length of stay and cost • National guidelines recommend In hospital glycemic targets of
__-___ mmol/L

Answer 1

Improving glycemic control improves patient outcomes
and reduces length of stay and cost • National guidelines recommend In hospital glycemic targets of
5-10 mmol/L

Question 2

Testing blood glucose with hospital approved meter at least 4
times/day:

When?

Answer 2

1. before each meal and bedtime
2. add 3am test if concerned about nocturnal hypoglycemia

Question 3

BBIT; general premise and what does each letter stand for?

Answer 3

a physiologic way to replace insulin, mimicking how the body natrually releases insulin

• Basal - long or intermediate-acting insulin administered once or twice daily to support the glucose released from the liver and to a lesser extent the kidneys
• Bolus - short or rapid acting insulin administered with meals
• to cover the glucose release from the anticipated meal
• Insulin Correction - short or rapid acting insulin given to correct unanticipated hyperglycemia
• Usually given with the bolus insulin
• Titration - insulin doses are to be titrated every 24-72 hours to achieve and maintain in-target BG values

Question 4

T/F BBIT is superior over sliding scale inicidence in terms of minimizing hy

Question 5

National guidelines recommend In hospital glycemic targets of 5-10 mmol/L. How to achieve these targets?

Answer 5

1. testing blood glucose with hospital approved meter at least 4 times/day
2. insulin
3. BBIT
4. avoid the use of outdated, unsafe, and unproven insulin protocols; sliding sclae insuline alone

Question 6

outline the findings of the Rabbit2 study that looked at the surgery outcomes in T1DM that did BBIT vs SSI

Answer 6

BBIT:

significant reduction in hyperglycemia

• decreased complications (wound infections, pneumonia, bacteremia, resp failure, acute renal failure)

Question 7

3 populat bolus rapid acting insulin

Answer 7

aspart (novorapid), lispro/humalog, humulin R

Question 8

4 common intermediate or long acting insulin

Answer 8

1. detemir (levemir)
2. glargine (lantus)
3. NPH (intermediate)
4. degludec (restricted access)

Question 9

Calculating BBIT

Answer 9

• based on patients characteristics

if more sensitive to insulin, use .4.5units/kg

if less sensitive to insulin, use .5-1.9units/kg

find your total, then dedicate 50% of the amount to basal insulin, then 50% to bolus insulin deivided into doses with each meal

Question 10

Someimtes you need to correct your insulin if blood glucose is above target. What is the type of correction insulin?

Answer 10

correction insulin is the same typpe as the rapid one used by the patient.

correction insulin is not routinely recommended at bedtime due to risk of hypoglycemia overnight

Question 11

T/F you should give insulin after the meal in BBIT

Answer 11

false. glucose check –> insulin given –> meal eaten.

Question 12

when should insulin doses be held?

Answer 12

There are very few instances where all insulin doses should be held
• When patient not eating (NPO), only the bolus dose of insulin should be
held; basal and correction insulin is continued
• Patients with type 1 diabetes ALWAYS need basal insulin to avoid
diabetic ketoacidosis (DKA)

Question 13

KEY POINT: if a pump is stopped, you must replace basal insulin within __hours to prevent DKA.

Answer 13

2 horus.

Question 14

do insulin pumps give basal insulin?

Answer 14

false. only uses rapi acting insulin. delivers a continuous infusion of rapid-acting insulin to cover the insulin basal needs. a bolus of insulin is given with each meal to correct high sugars.