Inpatient Mangment Of DM Flashcards
(20 cards)
What is the impact of hyperglycemia in hospitals?
Hyperglycemia increases morbidity, mortality, and length of stay (LOS).
What does the NICE-SUGAR study indicate about tight glycemic control?
Tight glycemic control (81-108 mg/dL) increases mortality risk.
What are the current recommendations for glycemic targets in hospitals?
Current recommendations favor less strict targets to avoid hypoglycemia.
When should insulin therapy be initiated for critically ill patients?
Initiate insulin therapy at BG ≥180 mg/dL.
What is the target blood glucose range for critically ill patients?
Maintain BG between 140–180 mg/dL.
What is the glycemic target for noncritically ill patients?
Maintain BG between 140–180 mg/dL.
What are the glycemic targets for pregnant patients?
Fasting BG <95 mg/dL, 1-hour postprandial BG ≤140 mg/dL, 2-hour postprandial BG ≤120 mg/dL.
What factors put patients at high risk for inpatient hyperglycemia?
Factors include severity of illness, glucocorticoids, enteral/parenteral nutrition, immunosuppressants, counterregulatory hormones, and proinflammatory cytokines.
What is the best treatment for inpatient hyperglycemia?
Insulin therapy (IV or subcutaneous) is the safest and most effective.
What is the starting rate for IV insulin infusion in critically ill patients?
Initiate at 0.1 unit/hr/kg body weight.
How should IV insulin infusion be adjusted?
Adjust hourly based on current BG and rate of change.
What should be done before discontinuing IV insulin infusion?
Give subcutaneous insulin before discontinuing IV insulin.
What is the typical basal insulin dose in relation to total daily dose (TDD)?
Basal insulin typically is 50% of TDD in patients with normal dietary intake.
How should prandial insulin be administered?
Rapid-acting insulin 0–15 minutes before meals; short-acting insulin 30 minutes before meals.
What is the recommended treatment for hypoglycemia in hospitalized patients?
Oral: 15–30 g of quick-acting carbohydrates; IV: 50 g dextrose 50% or 1 mg glucagon IM.
What is the definition of hypoglycemia in hospitalized patients?
Hypoglycemia is defined as BG <70 mg/dL.
What should be done if a patient is on steroids and has hyperglycemia?
Use bolus insulin for low-dose steroids and basal insulin for high-dose steroids.
How should insulin be adjusted for patients receiving enteral or parenteral nutrition?
Add regular insulin to TPN or use basal-bolus insulin for EN.
What should be done with diabetes medications before surgery?
Hold oral medications on the morning of surgery; adjust insulin doses as needed.
What should be considered in discharge planning for diabetic patients?
Use HbA1c to guide discharge regimen and provide clear instructions.
