By Vassilis L. Aravantinos
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Walsh J, Roberts R: Using Insulin. San Diego, Torrey Pines Press, 2003. Sarah V. Bull CHAPTER 4 INPATIENT MANAGEMENT OF DIABETES AND HYPERGLYCEMIA 1. Does evidence support intensive management of blood glucose in the hospital setting? The correlation between hyperglycemia and adverse outcomes in hospital inpatients has been well demonstrated. Although somewhat controversial, the data suggest that elevated blood glucose (BG) levels in general medicine and surgical patients, cardiac patients, and critically ill patients lead to an increase in mortality and morbidity.
Discuss the use of the various oral agents in the hospital setting. & Sulfonylureas: These drugs are long-acting medications metabolized by the kidney and liver that have significant potential for causing hypoglycemia in hospitalized patients who are eating erratically. Of note, glipizide is associated with less hypoglycemia than glyburide in patients with renal insufficiency. & Metformin: There is a risk of lactic acidosis when this agent is used in patients with hypoperfusion, renal insufficiency, congestive heart failure, hypoxemia, or chronic lung diseases.
5. Supplemental bolus insulin reduces the BG to within normal limits when a high glucose correction factor is used. 34. Calculate an initial basal rate for insulin pump therapy. & An established C:I ratio and CF on MDI is critical for a smooth transition to pump therapy. & To calculate an initial basal rate, take the current TDD of insulin on MDI and reduce it by 25% (or other appropriate reduction, depending on current hemoglobin A1C and number of hypoglycemic episodes). & Use 50% of the reduced dose as the total basal dose to be given over 24 hours.