Selecting a Treatment Regimen Hospitalized Patients
ÎFor most patients, a glucose concentration range of 140 to 180 mg/dL (7.8 to 10 mmol/L) has been recommended, provided these targets can be safely achieved.
ÎInsulin can rapidly control hyperglycemia and, therefore, is the drug of choice for hospitalized patients with hyperglycemia (D-4).
> Subcutaneous insulin orders should be specified as "basal," "prandial," or "correction" (D-4).
> Intravenous insulin is preferred for critically ill patients. Glucose Monitoring
> Regular insulin is acceptable for intravenous administration, but insulin analogues are preferred for subcutaneous administration.
practitioners should consider discontinuing them in favor of insulin during acute illness that might reasonably be expected to affect glucose levels and/or increase the risk for medication-related adverse events (D-4).
ÎHbA1c should be measured at least twice yearly in all patients with DM and at least 4 times yearly in patients not at target (D-4).
ÎSMBG should be performed by all patients using insulin (minimum of twice daily and ideally at least before any injection of insulin) (D-4).
> More frequent SMBG after meals or in the middle of the night may be required for insulin-taking patients with frequent hypoglycemia, patients not at HbA1c targets, or those with symptoms (D-4).
> Patients not requiring insulin therapy may benefit from SMBG, especially to provide feedback about the effects of their lifestyle and pharmacologic therapy.
Hypoglycemia
ÎHypoglycemia treatment requires oral administration of rapidly absorbed glucose (D-4).
ÎIf the patient is unable to swallow, parenteral glucagon may be given by a trained family member or by medical personnel (D-4).
ÎIn unresponsive patients, intravenous glucose should be given (D-4).
ÎPatients may need to be hospitalized for observation if an SU or a very large dose of insulin is the cause of the hypoglycemia because prolonged hypoglycemia can occur (D-4).
ÎIf the patient has hypoglycemic unawareness and hypoglycemia- associated autonomic failure, several weeks of hypoglycemia avoidance may reduce the risk or prevent the recurrence of severe hypoglycemia (A-1).
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> Testing frequency must be personalized (D-4). > Although still early in its development, continuous glucose monitoring can be useful for many patients to improve HbA1c levels and reduce hypoglycemia (D-4).
> Insulin dosing should be synchronized with provision of enteral or parenteral nutrition (D-4). > Exclusive use of "sliding scale insulin" should be discouraged (D-4). > Oral antihyperglycemic agents have a limited role in acute care settings;
