Hyperglycemia in Hospitalized Adult Patients
Essential Points
Essential Points
- Continuous glucose monitoring systems can effectively achieve glycemic targets and reduce hypoglycemia in hospitalized patients.
- Patients receiving glucocorticoid therapy or enteral nutrition are at high risk for hyperglycemia and require scheduled insulin therapy in the hospital.
- Patients using insulin pump therapy before hospital admission may self-manage these devices with oversight by hospital personnel.
- Diabetes self-management education to hospitalized patients can promote improved glycemic control with reductions in the risk for hospital readmission.
- Patients with diabetes scheduled for elective surgery may have improved postoperative outcomes when pre-operative hemoglobin A1c (HbA1c) is ≤8% and when blood glucose (BG) values in the immediate pre-operative period are <180 mg/dL.
- Providing pre-operative carbohydrate containing beverages to patients with known diabetes is not recommended.
- Patients with newly recognized hyperglycemia or well-managed diabetes on non-insulin therapy may be treated with correctional insulin alone as initial therapy at hospital admission.
- Scheduled insulin therapy is preferred for patients experiencing persistent blood glucose values >180 mg/dL.
- Dipeptidyl peptidase inhibitors can be used in combination with correction insulin in selected patients with type 2 diabetes who have milder degrees of hyperglycemia provided there are no contraindications to the use of these agents.
Definitions of Terms Used
...tions of Terms Used...
...Sliding scale insulin (SSI): Reactive appro...
Treatment
...atment...
Table 1. Currently Available Injectable Insulin Pr...
...1.1In adults with insulin-treated diabet...
...e 2. Resources Required for Safe Implementa...
...le 3. Methodology for Converting Insulin Pu...
...tion 2.1In adult patients who are hospital...
...mmendation 3.1In adult patients using insulin p...
...endation 4.1In adult patients with dia...
...5.1For adult patients with diabetes unde...
Recommendation 5.2For adult patient...
...ation 6.1In adult patients hospitalized for no...
...n 7.1In most adult patients with hyperglyce...
...mendation 7.2In select adult patients...
...8.1In adult patients with type 1 diabetes...
...mendation 9.1In adult patients with non-insulin...
...tion 9.2In adult patients with T1D, insulin-treate...
...mendations 9.1 and 9.2Remarks: Patients...
...commendation 10.1In adults with no prior history...
...mendation 10.2In adults with diabet...
Recommendation 10.3In adults with insulin-t...