SHM's Clinical Quick Talks-Inpatient Diabetes Management

Pdf Summary

This document discusses various aspects of inpatient diabetes management. <br /><br />One important consideration is the handling of oral diabetes medications at admission. It is typically recommended to hold these medications and replace them with insulin during the hospital stay. However, it is important to resume them at discharge if appropriate. Certain medications, such as metformin, can cause lactic acidosis, especially in the presence of acute kidney injury or hemodynamic changes. Sulfonylureas, on the other hand, can cause hypoglycemia, particularly if the patient is not eating. The newer diabetes agents have limited data, so they are generally held during hospitalization.<br /><br />The document also provides a table comparing different types of insulin. It illustrates the onset, peak, and duration of action for each type. It then poses a question regarding how long there needs to be an overlap between a continuous insulin drip and transitioning to glargine for a patient with diabetic ketoacidosis (1-2 hours).<br /><br />Insulin regimens are discussed, with options including continuing the patient's home insulin regimen or reducing the dose. Different options are presented, such as prn only (sliding scale insulin), basal (prn), and basal/bolus (prn). The pros and cons of each are outlined, with the conclusion that basal/bolus is likely the optimal choice for most patients.<br /><br />The document also provides dosing recommendations for basal/bolus regimens and discusses how to adjust the regimen if glucose values are too high. Several case scenarios are given, with proposed management plans for each. The reference for this information is cited as the "Management of Hyperglycemia in Hospitalized Patients in Non-Critical Care Setting: An Endocrine Society Clinical Practice Guideline."

Asset Subtitle

John Ragsdale

Keywords

inpatient diabetes management

oral diabetes medications

insulin

metformin

lactic acidosis

sulfonylureas

hypoglycemia

diabetes agents

types of insulin

insulin regimens