Current Diabetes Reports

, Volume 13, Issue 1, pp 96–106

Glycemic Management in Medical and Surgical Patients in the Non-ICU Setting

Authors

  • Kara Hawkins
    • Division of Endocrinology, Department of MedicineVA Pittsburgh Healthcare System
  • Amy C. Donihi
    • School of Pharmacy, Department of Pharmacy and TherapeuticsUniversity of Pittsburgh
    • Division of Endocrinology, Department of MedicineUniversity of Pittsburgh Medical Center
Hospital Management of Diabetes (G Umpierrez, Section Editor)

DOI: 10.1007/s11892-012-0340-1

Cite this article as:
Hawkins, K., Donihi, A.C. & Korytkowski, M.T. Curr Diab Rep (2013) 13: 96. doi:10.1007/s11892-012-0340-1

Abstract

Hyperglycemia is commonly observed in hospitalized patients with and without previously known diabetes and is associated with adverse outcomes. For this reason, measurement of blood glucose (BG) is recommended for all patients at admission. Measurement of an A1C identifies patients with either newly recognized diabetes or uncontrolled diabetes. Current guidelines advise fasting and premeal BG <140 mg/dl, with maximal random BG <180 mg/dl for the majority of noncritically ill patients. Rational use of basal bolus insulin (BBI) regimens is effective in achieving these glycemic goals, with low risk for hypoglycemia. The safety of BBI relies upon provider knowledge for initiation and adjustment of insulin doses for changes in nutritional status or use of medications affecting glucose metabolism. Smooth transition of care to the outpatient setting is facilitated by providing oral and written instructions regarding timing and dosing of insulin, as well as education in basic skills for home management.

Keywords

Type 1 diabetesType 2 diabetesHyperglycemiaInpatientsInsulinPerioperative careContinuity of patient careGlycemic managementMedical and surgical patientsNon-ICU setting

Abbreviations

BBI

Basal-bolus insulin

BG

Blood glucose

CSII

Continuous subcutaneous insulin infusion

DKA

Diabetic ketoacidosis

IDMP

inpatient diabetes management program

IV

Intravenous

POC

Point of care

SSI

Sliding scale insulin

RISS

regular insulin sliding scale

TGMP

Targeted glycemic management program

TDD

Total daily dose

Copyright information

© Springer Science+Business Media New York 2012