Term
| How is diabetes newly diagnosed? |
|
Definition
FBG > 126
Random BG > 200
A1C > 6.5
Can be hospital related, reverts to normal after discharged. |
|
|
Term
| Why is glucose higher in the hospital or infection? |
|
Definition
Stress response increases glucose, decreases insulin
- Increased reactive oxygen, immune dysfunction
- Leads to increased cell injury, acidosis
- A NEW hyperglycemia patient will have a longer hospital stay |
|
|
Term
| How does blood sugar affect mortality? |
|
Definition
| If BG > 150, mortality increases significantly. |
|
|
Term
| What are the goals for ICU and non-ICU patients? |
|
Definition
- Critical (ICU) patients goal 140-180, closer to 140 better for the patient.
- Non-critical (non-ICU) goal <140 fasting, random goal <180. Consider modifying if BG<100, required if <70 |
|
|
Term
| What do studies say about ICU patients w/ diabetes? |
|
Definition
| Intensive care (BG goal 80-110) decreases morbidity and mortality. No difference seen in-hospital death, but benefits seen in discharge |
|
|
Term
| What does the NICE-SUGAR trial say? |
|
Definition
| Unexpected result - tight glucose control increases risk of death. The reason why goal is a RANGE rather than specific. |
|
|
Term
| What do trials say about non-ICU patients? |
|
Definition
| There are no trials about non-ICU patients |
|
|
Term
| What is the therapy of choice for ICU and non-ICU patients? |
|
Definition
ICU - insulin infusion. IV regular insulin, not analogs
Non-ICU - SQ insulin
Preferred therapy is always insulin. Oral agents disliked. |
|
|
Term
| What are concerns about using oral agents in the hospital? |
|
Definition
- time to reach steady state
- AEs
- administration w/ food absorption |
|
|
Term
| What are clinical pearls on SUs (secretagogues) in the hospital? |
|
Definition
ALWAYS watch renal function b/c eliminated by kidneys
- Glyburide - ACTIVE metabolites, do not recommend for use
- Glipizide - mostly inactive, renally excreted
- Glimepiride - 2C9 active metabolite
Ischemic preconditioning |
|
|
Term
| What are clinical pearls about metformin in the hospital? |
|
Definition
- Risk of lactic acidosis: CHF, hypoperfusion due to damage, renal insufficiency (hold for contrast dye), older age, COPD
- GI discomfort |
|
|
Term
| What are clinical pearls for TZDs in the hospital? |
|
Definition
- Rosiglitazone associated with ischemic events
- Edema common
- Delay in onset, not good in the hospital |
|
|
Term
| How is IV insulin dose determined? |
|
Definition
| 50% of home regimen divided over 24 hours |
|
|
Term
| What are the components of non-ICU therapy |
|
Definition
- Basal - rapid + long acting
- Nutritional - may be a meal or IV
- Supplemental/Correction - corrects for high readings
If type 1, will need all 3. sickness increases insulin demand. |
|
|
Term
| What insulin is used for hospital basal dosing? |
|
Definition
| Insulin glargine/Lantus QPM, check BG in the morning. or Levemir in place of Lantus |
|
|
Term
| Which insulins are used for nutritional insulin options? |
|
Definition
Short acting insulins such as novolog before meals (TID), or humalog
Lag times:
- BG 80-99 lag time 0
- BG 100-199 lag time 10-20
- BG 20-299 lag time 20-30
- BG >300 lag time 30-40 |
|
|
Term
| What insulins are used for correction? |
|
Definition
Never use regular insulin, always use an analog
1500 (regular) or 1800 (analog) / total daily insulin = sensitivity factor. Use rapid acting analogs. |
|
|
Term
| When are insulin pumps used? |
|
Definition
Patients and providers are familiar with use and dosing
- Bolus dosing: 500/total insulin = carb ratio |
|
|
