Treatment
Î For patients with diabetes the ES recommends discontinuing oral and
noninsulin injectable antidiabetic agents before surgery and initiating
insulin in those who develop hyperglycemia during the perioperative
period. (1|⊕
)
Î When instituting subcut insulin therapy in the postsurgical setting, the
ES recommends basal (for patients who are NPO) or basal/bolus plus
correction if needed (for patients who are eating) insulin as the preferred
approach. (1|⊕⊕⊕
)
Glucocorticoid-Induced Diabetes
Î For patients with or without a history of diabetes receiving glucocorticoids,
the ES recommends initiating bedside POC testing. (1|⊕⊕⊕
)
Î The ES suggests discontinuing POC testing in nondiabetic patients if all
BG results are < 7.8 mmol/L (140 mg/dL) without insulin for a period of at
least 24-48 h. (2|⊕
)
Î The ES recommends initiating insulin for patients with persistent
hyperglycemia while receiving glucocorticoid therapy. (1|⊕⊕
)
Î The ES suggests CII as an alternative to subcut insulin for patients with
severe and persistent elevations in BG despite use of scheduled basal
bolus subcut insulin. (2|⊕
)
Transition from CII to Subcut Insulin
Î The ES recommends transition to scheduled subcut insulin at least 1-2 h
before discontinuation of CII for all patients with type 1 and type 2
diabetes. (1|⊕⊕⊕⊕)
Î The ES recommends administering subcut insulin before discontinuation
of CII for patients without a history of diabetes who have hyperglycemia
requiring more than 2 units/h. (1|⊕⊕⊕⊕)
Î The ES recommends POC testing with daily adjustment of the insulin
regimen after discontinuation of CII. (1|⊕⊕⊕
)
Hypoglycemia
Î The ES recommends implementing glucose management protocols
with specific directions for hypoglycemia avoidance and hypoglycemia
management in the hospital. (1|⊕⊕
)
Î The ES recommends implementing a standardized hospital-wide,
nurse-initiated hypoglycemia treatment protocol to prompt immediate
therapy of any recognized hypoglycemia, defined as a BG < 3.9 mmol/L
(70 mg/dL). (1|⊕⊕
)
Î The ES recommends implementing a system for tracking the frequency of
hypoglycemic events with root cause analysis of events associated with
potential for patient harm. (1|⊕⊕
)
