Current Diabetes Reports

, Volume 13, Issue 1, pp 96–106 | Cite as

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

  • Kara Hawkins
  • Amy C. Donihi
  • Mary T. Korytkowski
Hospital Management of Diabetes (G Umpierrez, Section Editor)

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 diabetes Type 2 diabetes Hyperglycemia Inpatients Insulin Perioperative care Continuity of patient care Glycemic management Medical and surgical patients Non-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

Notes

Disclosure

Conflicts of interest: K. Hawkins, none; A. C. Donihi, none; M. T. Korytkowski has a board membership with the American Diabetes Association (volunteer position), was a consultant for Regeneron, and has received grant support and honoraria from Sanofi-Aventis.

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Copyright information

© Springer Science+Business Media New York 2012

Authors and Affiliations

  • Kara Hawkins
    • 1
  • Amy C. Donihi
    • 2
  • Mary T. Korytkowski
    • 3
  1. 1.Division of Endocrinology, Department of MedicineVA Pittsburgh Healthcare SystemPittsburghUSA
  2. 2.School of Pharmacy, Department of Pharmacy and TherapeuticsUniversity of PittsburghPittsburghUSA
  3. 3.Division of Endocrinology, Department of MedicineUniversity of Pittsburgh Medical CenterPittsburghUSA

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