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Diabetes Mellitus Control in Hospital
- See Also
- Insulin Sliding Scale
- Hourly Subcutaneous Insulin Lispro
- Insulin Infusion
- Complications: Uncontrolled Blood Glucose
- Decreased survival
- Increased cardiac or Cerebral Infarction
- Increased infectious disease
- Post-surgical hyperglycemia correlates to complications
- Diabetes Mellitus confers 2 relatve risk complication
- BG >200 mg/dl confers >3 relative risk complication
- BG >250 mg/dl confers >12 relative risk complication
- (2002) :
- Targets: Hospitalized Blood Glucose control in ICU
- Monitor Blood Glucose every 2-4 hours
- ICU goal Blood Glucose: 70-200 mg/dl (ideally <140)
- Treat Hypoglycemia with D50 IV
- Diagnosis: Evaluate on hospitalization
- Check fasting Blood Glucose
- Hemoglobin A1C on admission
- Protocol: Complete Insulin Orders
- Basal Insulin: Long acting Insulin (e.g. Lantus, NPH)
- Do not adjust Lantus for PO intake
- NPH may require adjustment if covering mealtime
- Bolus Insulin: Lispro, Aspart
- Cover meals, snacks with units per carbohydrate
- Hypoglycemia Management
- Hyperglycemia coverage: Sliding scale coverage
- Cover as units per glucose 50 mg/dl over 150 mg/dl
- Adjust per condition
- Lower doses
- Low weight Type I Diabetes Mellitus
- Renal Failure (Insulin 50% renal excreted)
- Higher dose
- Large Type II Diabetes Mellitus
- Corticosteroid use
- Sepsis or severe illness
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