Treatment
Transition from Home to Hospital
Î For all patients with diabetes treated with insulin at home, the ES
recommends a scheduled subcut insulin regimen in the hospital. (1|⊕⊕⊕⊕)
Î The ES suggests discontinuing oral hypoglycemic agents and initiating
insulin for the majority of patients with type 2 diabetes at the time of
hospital admission for an acute illness. (2|⊕
)
Î For patients treated with insulin before admission, the ES suggests
modifying their insulin dose according to clinical status as a way of reducing
the risk for hypoglycemia and hyperglycemia. (2|⊕
)
• Glucose and HbA1c values, together with the medical history, can be used to tailor
therapy and assist in discharge planning.
Pharmacologic Therapy
Î The ES recommends insulin as the preferred method for achieving glycemic
control in hospitalized patients with hyperglycemia. (1|⊕⊕
)
Î During hospitalization the ES suggests avoiding prolonged use of sliding
scale insulin (SSI) as the sole method for glycemic control in hyperglycemic
patients with and without a history of diabetes. (2|⊕
)
Î The ES recommends that scheduled subcut insulin consist of basal insulin
given once or twice a day in combination with rapid or short-acting insulin
administered before meals in patients who are eating. (1|⊕⊕⊕
)
Î The ES suggests including correction insulin as a component of a scheduled
insulin regimen for treatment of BG values above the target level. (2|⊕
)
Patients Receiving EN or PN
Î The ES recommends POC testing for patients with or without a history of
diabetes receiving EN and PN. (1|⊕⊕⊕⊕)
Î The ES suggests discontinuing POC testing in patients without a prior
history of diabetes if BG values are < 7.8 mmol/L (140 mg/dL) without
insulin for 24-48 h after achievement of desired caloric intake. (2|⊕
)
Î The ES suggests initiating scheduled insulin in patients with and without
known diabetes who have hyperglycemia, defined as BG > 7.8 mmol/L
(140 mg/dL), and who demonstrate a persistent requirement (ie, > 12-24 h)
for correction insulin. (2|⊕
)
Perioperative BG Control
Î The ES recommends that all patients with type 1 diabetes who undergo
minor or major surgical procedures receive either continuous insulin
infusion (CII) or subcut basal insulin with bolus insulin as required to
prevent hyperglycemia during the perioperative period. (1|⊕⊕⊕⊕)
