Endocrine: Inpatient DM & Hyperglycemia

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  1. Unrecognized DM
    FBG >/= 126 or random >/= 200 and confirmed after hospitalization


    HgbA1c > 6.5%
  2. Stress Hyperglycemia
    Any BG > 140 during hospitalization that normalizes after discharge
  3. Hypoglycemia
  4. Severe hypoglycemia
  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


    • 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
Card Set:
Endocrine: Inpatient DM & Hyperglycemia
2013-04-21 19:58:06
endocrine inpatient diabetes hyperglycemia

Overview of inpatient treatment of DM and associated hyperglycemia
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