Abstract
The prevalence of diabetes in the USA continues to grow at an alarming rate. While the risk factors for diabetes complications are well defined, many patients are not achieving recognized treatment goals and are at risk of developing complications, including peripheral vascular disease and podiatric problems. There are two major types of diabetes—Type 1 and Type 2. Type 1 diabetes develops into a from of insulin production while Type 2 diabetes develops because of insulin resistance with an inadequate supply of insulin to meet the increased need. When patients with diabetes are admitted to the hospital, they will almost always require insulin therapy. Optimal insulin coverage includes basal (background) insulin in conjunction with insulin. The bolus insulin dose is composed of a prandial (meal) component and a correction dose as needed. For patients eating normally the total daily dose of prandial insulin is approximately equal to the total basal dose. Based on a patient’s total daily insulin requirement, one can calculate a correction factor or the amount of blood glucose lowering expected from 1 unit of insulin. Patients with Type 1 diabetes, because of their lack of insulin production, can never have all of their insulin held because of the risk of developing DKA. Adjustments in both the basal and bolus doses are required preoperatively. Patients in the ICU are best managed with an intravenous insulin infusion with dosing based on a validated protocol. Early discharge planning can help avoid delays in discharge due to diabetes-related issues.
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References
Centers for Disease Control and Prevention. National diabetes fact sheet: general information and national estimates on diabetes in the United States, 2010. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention; 2011.
The Diabetes Control and Complications Trial Research Group. The Effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med. 1993;329:977–86.
UK Prospective Diabetes Study Group. Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35). BMJ. 2000;321:405–12.
Lloyd-Jones D, Adams RJ, Brown TM, on behalf of the American Heart Association Statistics Committee and Stroke Statistics Subcommittee, et al. Heart disease and stroke statistics 2010 update. A report from the American Heart Association. Circulation. 2010;121:e46–215.
Saydah SH, et al. National Health Examination Survey (NHANES), 1999-2000. JAMA. 2004;291:335–42.
Kahn CR. The molecular mechanism of insulin action and the regulation of glucose and lipid metabolism. In: Kahn CR, Weir GC, King GL, Jacobson AM, Moses AC, Smith RJ, editors. Joslin’s diabetes mellitus. 14th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2005. p. 146–54.
Pundziute-Lycka A, Dahlquist G, Nystrom L, Arnqvist H, Bjork E, Blohme G, Bolinder J, Eriksson JW, Sundkvist G, Ostman J. Swedish Childhood Diabetes Study Group: the incidence of type I diabetes has not increased but shifted to a younger age at diagnosis in the 0–34 years group in Sweden 1983–1998. Diabetologia. 2002;45:783–91.
Melton 3rd LJ, Palumbo PJ, Chu CP. Incidence of diabetes mellitus by clinical type. Diabetes Care. 1983;6:75–86.
Krolewski AS, Warram JH, Rand LI, Kahn CR. Epidemiologic approach to the etiology of type 1 diabetes mellitus and its complications. N Engl j Med. 1987;317:1390–8.
Bennett PH, Knowler WC. Definition, diagnosis and classification of diabetes mellitus and glucose homestasis. In: Kahn CR, Weir GC, King GL, Jacobson AM, Moses AC, Smith RJ, editors. Joslin’s Diabetes Mellitu. 14th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2005. p. 333.
Alberti KGMM. Diabetic acidosis, hyperosmolar coma and lactic acidosis. In: Becker KL, editor. Principles and practice of endocrinology and metabolism. 3rd ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2001. p. 1438–9.
Alberti KGMM. Diabetic acidosis, hyperosmolar coma and lactic acidosis. In: Becker KL, editor. Principles and practice of endocrinology and metabolism. 3rd ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2001. p. 1446–7.
Diabetes. http://www.cdc.gov/diabetes/statistics/hosplea/diabetes_complications/fig5.htm. Accessed September 19, 2010.
Diabetes. http://www.cdc.gov/diabetes/statistics/lea/fig1.htm. Accessed February 27, 2012.
Clement S. Braithwaite SS, MaGee MF, Ahmann A, Smith EP, Schafer RG. Hirsch IB on behalf of the American Diabetes Association Diabetes in Hospitals Writing Committee Management of Diabetes and Hyperglycemia in Hospitals Diabetes Care. 2004;27:553–91.
Moghissi ES, Korytkowski MT, DiNardo M, Einhorn D, Hellman R, Hirsch IB, Inzucchi SE, Ismail-Beigi F, Kirkman MS, Umpierrez GE. American Association of Clinical Endocrinologists and American Diabetes Association Consensus Statement on Inpatient Glycemic Control. Endocrine Practice. 2009;15(4):353–69.
Levetan CS, Passaro M, Jablonski K, Kass M, Ratner RE. Unrecognized diabetes among hospitalized patients. Diabetes Care. 1998;21:246–9.
Umpierrez GE, Isaacs SD, Bazargan N, You X, Thaler LM, Kitabchi AE. Hyperglycemia: an independent marker of in-hospital mortality in patients with undiagnosed diabetes. J Clin Endocrinol Metab. 2002;87:978–82.
Moghissi ES, Korytkowski MT, DiNardo M, Einhorn D, Hellman R, Hirsch IB, Inzucchi SE, Ismail-Beigi F, Kirkman MS, Umpierrez GE. American association of Clinical Endocrinologists and American Diabetes Association consensus statement on inpatient glycemic control. Endocrine practice. 2009;15(4):1–17.
Umpierrez GE, Smiley D, Zisman A, Prieto LM, Palacio A, Ceron M, Puig A, Mejia R. Randomized study of basal-bolus insulin therapy in the inpatient management of patients with type 2 diabetes (RABBIT 2 Trial). Diabetes Care. 2007;30:2181–6.
Levemir package insert. Princeton, NJ: Novo-Nordisk, Revised May 16, 2007.
Lantus package insert. Bridgewater, NJ: Sanofi-Aventis US. Revised March 2007.
J Walsh PA, R Roberts MA, T Bailey MD, and C Varma MD. Everything you need for success with insulin. Torrey Pines Press. 2003.
Krinsley JS. Association Between Hyperglycemia and Increased Hospital Mortality in a Heterogeneous Population of Critically Ill Patients. Mayo Clin Proc. 2003;78:1471–8.
Van den Berghe G, et al. Intensive insulin therapy in critically ill patients. N Engl J Med. 2001;345:1359–67.
The NICE-SUGAR Study Investigators. Intensive versus conventional glucose control in critically ill patients. N Engl J Med. 2009;360:1283–97.
Wolpert HA. Treatment of diabetes in the hospitalized patient. In: Kahn CR, Weir GC, King GL, Jacobson AM, Moses AC, Smith RJ, editors. Joslin’s diabetes mellitus. 14th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2005. p. 1106.
Haag BJ. Perisurgical management of the patient with diabetes. In: Leahy JL, Clark NG, Cefalu WT, editors. Medical management of diabetes mellitus. New York, NY: Marcel Dekker; 2000. p. 636.
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Snow, K. (2012). Principles of Care in the Diabetic Surgical Patient. In: Veves, A., Giurini, J., LoGerfo, F. (eds) The Diabetic Foot. Contemporary Diabetes. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-61779-791-0_1
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