Acute Care Dysglycemia Flashcards
(54 cards)
How often do you monitor a patient’s glucose level if they are on an IV insulin drip?
every 30 min to 2 hours
How often do you monitor a patient’s glucose level if they are on a TPN or enteral nutrition?
Q4H
How often do you monitor a patient’s glucose level if they are NPO?
Q4-6H
How often do you monitor a patient’s glucose level if they are a regular patient in the hospital?
Q6H for at least the first 48 hours
How often do you monitor a patient’s glucose level if they are stable?
Q8-12H
What are the glucose goals for patients in the medical-surgical ward?
Random: less than 180
Fasting: less than 140
What are the glucose goals for patients in the ICU? What if the patient is in SICU or CICU?
Random: 180 or less
Goal range: 140-180
SICU/CICU: 110-140
How often should an insulin sliding scale be adjusted?
every 1-2 days
What patients should receive an insulin infusion?
• hyperglycemic crisis
• poorly controlled DM despite SC insulin
– BG > 350 mg/dL for more than 12 hrs
• TPN + uncontrolled hyperglycemia
• DM pts who are NPO, preoperative, or in Labor & Delivery (L&D)
• post-MI or ACS patients with hyperglycemia
• Any ICU patient with hyperglycemia
How do you prepare an insulin infusion?
Mix 100 units of regular insulin in 100 cc of 0.9% NaCl (or 0.45% NaCl)
Run at least 20 cc through the tubing before initiating infusion (to prevent the insulin from sticking to the tubing)
What is the initial dose for patients on a insulin infusion? When would this rate be higher?
0.1-0.15 units/kg
Rate may be higher in those who are . . . • insulin-resistant • obese • on steroids • severely hyperglycemic
How often should you check a patient’s glucose level if they are on an insulin infusion?
What is the goal for decreasing the BG?
every hour for 4-6 hours until patient is stable
Goal: decrease BG ~ 50-75 mg/dL
What are the general rules for adjusting an insulin infusion?
if BG decreases by > 100 mg/hr —> decrease rate by 25-50%
if BG increases or no change after 1-2 h —> increase rate by 50-100%
if BG is within goal targets —> continue same rate
Before transitioning from IV —> SQ insulin you should give . . .
short/rapid-acting insulin 1-2 hours before stopping the IV OR
intermediate/long-acting 2-3 hours before stopping the IV
What is one approach to switching from insulin infusion (IV) —> SQ insulin?
- determine the average hourly IV insulin rate for the past 6 hours
- multiply the number by 20 to get average adjusted TDD!
• give 50% as BASAL insulin
Detemir q 12 h or Glargine q 24 h
NPH q 12 h
• give 50% as BOLUS dose in divided doses (divide by 3)
What are some Precipitating Factors that may cause hyperglycemic crisis?
- Infection
- Inadequate insulin therapy or noncompliance
- New onset diabetes
- Other acute illness (CVA, AMI, pancreatitis)
- Medications
• Corticosteroids
• Thiazides
• Sympathomimetic agents (ex. dobutamine, epinephrine)
• Antipsychotic medications (ex. Quetiapine)
• SGLT2 inhibitors (May 2015)
Absolute and/or relative insulin deficiency and elevated counter regulatory hormones which results in hyperglycemia
hyperglycemic crisis
Absolute and/or relative insulin deficiency and elevated counter regulatory hormones which results in hyperglycemia
hyperglycemic crisis
Clinical presentation of DKA and HHS?
polyuria polydipsia weight loss dehydration poor skin trudger tachycardia hypotension mental status change
DKA develops within . . .
hours
HHS develops within . . .
days to weeks
_______ may have a Fruity breath odor
DKA
______ has Kussmaul respirations
DKA
______ has Kussmaul respirations
DKA
