SHM's Clinical Quick Talks-Inpatient Diabetes Management

Pdf Summary

The document titled "Inpatient Diabetes Management" is authored by Hannah Cleary and John Ragsdale, MD, MS, addressing the HM Core Competency of Diabetes Mellitus. It provides guidance on managing diabetes in hospitalized patients, focusing on insulin regimens. The key points include the usual practice of holding oral diabetes medications upon admission, often replacing them with insulin, and resumes them at discharge if appropriate. Metformin is traditionally held due to perceived risks of lactic acidosis, though newer evidence is reshaping this view. Sulfonylureas are typically avoided as they may lead to hypoglycemia, especially in patients who are not eating.<br /><br />The document outlines the types of insulin, detailing their onset, peak, and duration. It suggests processes for initiating insulin regimens in patients not on insulin at home, evaluating scenarios for the administration of basal, bolus, and prn (as-needed) insulin strategies, and weighing the pros and cons of each approach. Basal/Bolus insulin regimens present the best physiologic glucose level management, especially for those uncontrolled at baseline, and is optimal when tight control is necessary.<br /><br />The dosing guidelines recommend a single daily basal dose or a detailed basal/bolus ratio, emphasizing individualized adjustments based on age, control level, and the presence of comorbidities. A basal/bolus regimen involves dividing the total daily insulin dose equally between basal and bolus, with the latter portioned out for meals.<br /><br />Several patient scenarios illustrate practical applications of these guidelines, reinforcing the importance of adjusting regimens based on specific patient needs and clinical states. Clinical pearls emphasize the preference for insulin to manage inpatient diabetes, with basal/bolus regimens offering the most precise control. The document references trusted resources from the American Diabetes Association and the Endocrine Society for further information on hospital diabetes care.

Asset Subtitle

Hannah Cleary, John Ragsdale

Keywords

Inpatient Diabetes Management

insulin regimens

oral diabetes medications

Metformin

Sulfonylureas

basal/bolus insulin

hospitalized patients

lactic acidosis

hypoglycemia

American Diabetes Association