Inpatients are Different | Target glucose | Insulin Management | Diet | Standing orders and practices |
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What is "Inpatients are Sicker?"
Glucose levels of inpatient diabetics are more labile because of this reason
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What is "hypoglycemia"
This serious complication led the ADA to change the recommendations (more than 10 years ago) of tight glucose control of 80-110 to moderate range of 140-180
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What is :"basal (long acting) insulin"
The normal pancreas makes this "type" of insulin every moment of every day, sick or well, eating or not. (Hint: rhymes with an Italian herb)
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What is "reduce home insulin regimen".
Because inpatients typically eat fewer calories/ carbohydrates THAN at home, this adjustment should be made on admission MW
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What is "Provide a source of glucose for all patients who are NPO?" or ensure access to a source of glucose
Hypoglycemic events in radiology or other procedural departments can be prevented by this.
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What is "The Liver"
In a healthy diabetic glucose stores are kept in this organ
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What is "70mg/dl"
Hypoglycemia in diabetic inpatients is defined as any glucose below this level
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What is "nutritional (bolus) insulin?"
The normal pancreas responds to a meal by releasing a surge if this "type" of insulin.
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What is "counting/assessing/estimating carbohydrates eaten"?
This task is key to effectively determining the amount of nutritional (bolus) insulin needed for each meal.
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What is "Allowing nurses to start peripheral lines with D10"?.
This standing nursing order helps PREVENT hypoglycemia when a TPN line comes out accidentally or TPN is stopped
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What is "nurse or doctor"? They cannot rescue themselves in the hospital like they would at home. When sick diabetics get hypoglycemia they are dependent on this person(s) for rescue. |
What is 140-180 mg/dL?
This glucose range is the target for diabetic inpatients.
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What is "correction (short acting) insulin"?
Because we estimate the amount of basal (long acting) and nutritional (bolus) insulin needed in the hospital, we must also use this category of insulin to fine tune the glucose
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What is "the patient"?
This free and readily available resource is often underused in the management of inpatient diabetes
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What is "Notify the provider and request reduction of basal/bolus insulin"?
This standing order directs the nurse to do this whenever the the blood glucose is < 70mg/dl in addition to starting the hypoglycemic protocol
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What is "the brain"
This organ can neither synthesize nor store glucose making is susceptible to harm from hypoglycemia
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What are "infections, longer LOS, higher mortality"? (Any one answer)
Inpatient glucoses above 220 mg/dL can cause this poor outcome.
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What is "basal(long acting)insulin" ?
EVERY (diabetic and non diabetic) patient in the hospital whose glucose can not be controlled < 180-220 mg/dL at all times should be switched to this method of glycemic control.
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What is "15 minutes before eating to 15 minutes after eating?"
Nutritional (bolus) insulin should be administered during this window of time relative to food intake.
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What is "Interview the patient to find out at what glucose they feel "low", and what works for them to quickly return their glucose to normal?"
Routinely interviewing the patient on admission and documenting this information breeds patient trust and helps prevent/recognize hypoglycemia.
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What is "one to two days prior to discharge"
If a patient's oral agents are changed to insulin in the hospitals when should the oral agents be reinstated?
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What is 70-100?
This glucose range is the target for a well diabetic at home.
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What is "sliding scale insulin alone"?
This "retroactive chasing your tail" glucose management strategy is outdated by > 20 years and leads to the most common hypo and hyper glycemic events, and should be abandoned!
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What is "POCT, insulin administration, and meal delivery?"
The division of these three tasks creates challenges in coordinating meals and insulin.
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What are "Continuous Glucose Monitoring and Insulin Pump Delivery"
Modern diabetes management can be done by many patients themselves even better than by hospitals by using these 2 devices in concert.
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