Inpatient Diabetes Management (Made Ridiculously Simple)-Slides

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This presentation by Dr. Mihail Zilbermint focuses on simplified inpatient diabetes management, highlighting the critical importance of glucose control during hospitalization. Key points include recognizing hyperglycemia’s impact—linked to significantly increased in-hospital mortality, infections, longer stays, and readmissions—and understanding glycemic targets for hospitalized patients, generally advised between 140-180 mg/dL.<br /><br />Hospitalized patients should have early blood glucose assessment, history review, and add-on HbA1c testing to guide diagnosis and management. For mild hyperglycemia, especially in type 2 diabetes, DPP-4 inhibitors like sitagliptin may be safe and effective. Moderate or severe hyperglycemia often necessitates basal insulin therapy, starting conservatively at 0.15–0.3 units/kg, with a 50/50 basal-nutritional insulin split, supplemented by correctional insulin based on glucose monitoring.<br /><br />The Endocrine Hospitalist model aims to improve glycemic control, reduce length of stay and readmissions, and lower costs. Emphasis is placed on patient safety to avoid insulin dosing errors and hypoglycemia, recommending cautious insulin dosing tailored to individual patient factors.<br /><br />For critically ill patients or extreme hyperglycemia, insulin infusion protocols are advocated, while basal-bolus regimens are adjusted according to intake, renal function, and clinical status. Nutritional insulin administration postprandially is associated with better glucose control.<br /><br />Effective discharge planning includes continuation or adjustment of diabetes medications (e.g., metformin, SGLT2 inhibitors, GLP-1 receptor agonists), patient education, and ideally use of continuous glucose monitoring (CGM) programs post-discharge to improve outpatient diabetes management and reduce readmissions.<br /><br />Overall, the approach is pragmatic and patient-centered, balancing glycemic targets, safety, and ease of use, while integrating emerging therapies and technology to enhance inpatient and transitional diabetes care.

Keywords

inpatient diabetes management

glucose control

hyperglycemia

glycemic targets

HbA1c testing

DPP-4 inhibitors

basal insulin therapy

Endocrine Hospitalist model

insulin infusion protocols

continuous glucose monitoring