Treatment
ÎFor 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|⊕)
ÎWhen 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
ÎFor patients with or without a history of diabetes receiving glucocorticoids, the ES recommends initiating bedside POC testing. (1|⊕⊕⊕)
ÎThe 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|⊕)
ÎThe ES recommends initiating insulin for patients with persistent hyperglycemia while receiving glucocorticoid therapy. (1|⊕⊕)
ÎThe 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
ÎThe 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|⊕⊕⊕⊕)
ÎThe 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|⊕⊕⊕⊕)
ÎThe ES recommends POC testing with daily adjustment of the insulin regimen after discontinuation of CII. (1|⊕⊕⊕)
Hypoglycemia
ÎThe ES recommends implementing glucose management protocols with specific directions for hypoglycemia avoidance and hypoglycemia management in the hospital. (1|⊕⊕)
ÎThe 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|⊕⊕)
ÎThe 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|⊕⊕)
