Endocrine: Inpatient DM & Hyperglycemia

Card Set Information

Author:
jcbarbery
ID:
214866
Filename:
Endocrine: Inpatient DM & Hyperglycemia
Updated:
2013-04-21 15:58:06
Tags:
endocrine inpatient diabetes hyperglycemia
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Description:
Overview of inpatient treatment of DM and associated hyperglycemia
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  1. Unrecognized DM
    FBG >/= 126 or random >/= 200 and confirmed after hospitalization

    OR

    HgbA1c > 6.5%
  2. Stress Hyperglycemia
    Any BG > 140 during hospitalization that normalizes after discharge
  3. Hypoglycemia
    <70
  4. Severe hypoglycemia
    <40
  5. Iatrogenic agents
    • Glucocorticosteroids
    • Vasopressors
    • Octreotide
    • Thiazides
    • Atypical antipsychotics
    • Protease inhibitors
  6. BG Goals in Crit. Ill Pts
    Maintain 140-180

    (<110 not recommended)
  7. BG Goals in Non-Crit. Ill Pts
    • FBG < 140
    • Random < 180
  8. SC Inpatient insulin
    Basal/bolus 50/50 strategy as T1DM

    Avoid bolus in NPO pts
  9. IV Insulin Preferred Pts
    DKA or non-ketotic hyperosmolar state

    Surgical pts

    Organ transplantation

    AMI or cardiogenic shock

    Stroke

    • Exacerbated hyperglycemia 2o to glucocorticoid Tx
    •   
    • NPO status in type 1 DM

    Critically ill patients (esp. w/ mech. vent.)
  10. Hypoglycemia RFs
    Sudden NPO status or PO reductions

    Enteral feedings or TPN D/C'd

    Pre-meal insulin given and meal not ingested

    Unexpected transport after bolus

    Reduction in corticosteroid dose

    D/C of med that causes hyperglycemia
  11. Hypoglycemia Tx
    15g carbs (4 oz juice/soda, 8oz non-fat milk, 3-4 glucose tabs)

    25-50 mL D50 IV push

    finger stick q15m and repeat if <80

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