Rapid Clinical Updates: Inpatient Management of Diabetes-Presentation

Video Transcription

Video Summary

This hospital medicine session reviewed current inpatient diabetes management and highlighted how care is becoming more individualized. Dr. Lily Ackerman covered the basics: hyperglycemia in the hospital is common and harmful, especially stress hyperglycemia in patients without known diabetes. She reviewed ADA targets, emphasizing that inpatient insulin goals are generally around 100–180 mg/dL, and that sliding scale insulin alone should not be used for most patients. Instead, physiologic regimens should include basal insulin, nutritional insulin when eating, and correctional insulin. She also discussed special situations such as steroid-induced hyperglycemia, enteral/parenteral nutrition, and discharge planning. Discharge education, A1C checking, follow-up within 1–2 weeks, and attention to social/financial barriers were stressed.<br /><br />Dr. Guillermo Ampariz expanded on newer evidence showing that not all hospitalized patients need full basal-bolus therapy. He emphasized that many patients do well with basal-plus correction, especially if insulin-naive and only mildly hyperglycemic. He reviewed studies showing basal-bolus is superior to sliding scale in significantly hyperglycemic patients, but also noted that sliding scale or oral agents may be reasonable in selected patients with mild hyperglycemia and low A1C. DPP-4 inhibitors have the best inpatient oral-agent data, while GLP-1 agents may work but can cause nausea. He also discussed discharge strategies, warning against overtreatment and post-discharge hypoglycemia.<br /><br />Both speakers discussed continuous glucose monitoring (CGM) as a promising future tool for inpatient care, though point-of-care testing remains the current standard. The session closed with practical Q&A on steroid dosing, insulin adjustments, and use of SGLT2 inhibitors in older adults.

Keywords

inpatient diabetes management

hospital hyperglycemia

basal-bolus insulin

sliding scale insulin

stress hyperglycemia

steroid-induced hyperglycemia

discharge planning

continuous glucose monitoring

DPP-4 inhibitors

hypoglycemia prevention