6
Recommendation 2.1
➤ In adult patients who are hospitalized for non-critical illness and
experience hyperglycemia while receiving glucocorticoids (GCs), we
suggest glycemic management with either NPH-based insulin or basal-
bolus insulin regimens. (2|⊕⊕
)
Remarks:
▶ An NPH-based regimen may consist of NPH (with or without prandial insulin) given
in divided doses depending on the timing, pharmacokinetics and frequency of the specific
GC being administered. NPH insulin may be added to BBI if the patient is already on
this regimen.
▶ Management of patients with GC-associated hyperglycemia requires ongoing BG
monitoring with adjustment of insulin dosing. All therapies require safeguards to avoid
hypoglycemia when doses of GCs are tapered or abruptly discontinued.
Recommendation 3.1
➤ In adult patients using insulin pump therapy for diabetes management
prior to admission for non-critical illness, we suggest that these
patients continue insulin pump therapy rather than changing to
subcutaneous (SC) BBI therapy in hospitals with access to personnel
with expertise in insulin pump therapy. Where expertise is not
accessible, we suggest that patients with anticipated hospital length of
stay (LOS) of more than 1–2 days be transitioned to scheduled SC BBI
before discontinuation of an insulin pump. (2|⊕⊕
)
Remarks:
▶ Patients with an impaired level of consciousness, inability to appropriately adjust
pump settings, critical illness (intensive care unit [ICU] care), diabetic ketoacidosis,
or hyperosmolar hyperglycemic state are not candidates for inpatient use of the insulin
pump. Any change in a patient's condition that would interfere with their ability to
safely self-manage the insulin pump device requires removal and transition to SC
therapy (Table 3). Availability of supplies (provided by the patient or patient's family)
over the course of the hospitalization is necessary. Adaptation of the basal rate might be
needed at time of admission.
▶ Patients using hybrid closed loop insulin pump therapy may be able to continue this at
time of admission if they meet criteria similar to that for patients using insulin pump
therapy independently of a CGM device as long as the CGM and insulin pump are able
to function without interference with hospital care. If CGM fails or is removed from the
patient, the insulin pump can be reverted to manual mode as long as basic criteria for
pump use in hospital are still met.
▶ Hospitals need to have policies, procedures including patients' informed consent, and
standardized order sets in place as well as expertise from a health care professional who
is knowledgeable in insulin pump therapy. These policies and procedures should include
information for management of insulin pump devices during magnetic resonance
imaging, computed tomography, or other imaging studies, in addition to any surgical
procedures.
Treatment
