Managing Diabetes and Hyperglycemia in the Hospital: Critically Ill and Surgical Patients

Hospitalized patients with diabetes require specific medical management in order to minimize the risk of hyperglycemia. This requires hospitalists to have an understanding of methods for glycemic control in both the critically ill and noncritically ill patient. This activity, which focuses on the critically ill hospitalized patient, is part of a 2-part series that will evaluate the current scientific evidence regarding glycemic control and discuss how to formulate preoperative and postoperative intensive care unit plans. In addition, a thorough review of the evidence for intraoperative glycemic control and a discussion of how to transition patients off of an insulin drip are provided.

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Availability

On-Demand

Expires on Aug 01, 2026

Cost

Member: $0.00

Non-Member: $95.00

Credit Offered

2 CME Credits

2 ABIM-MOC Points

2 Participation Credits

Overview
Faculty
Accreditation
Recommended

Learning Objectives
After completing this activity, learners should be able to:

Evaluate the current scientific evidence regarding glycemic control in the critically ill hospitalized patient, especially in the postoperative patient.
Formulate a preoperative plan for patients with diabetes.
Appraise the evidence for intraoperative glycemic control and make recommendations for intraoperative care.
Formulate a postoperative intensive care unit treatment plan, including insulin drips.
Summarize the indications and process to transition off an insulin drip, including computation of a subcutaneous insulin regimen.

If you are a Program Director and would like to grant access to your trainees, please reach out to education@hospitalmedicine.org for an academic access code.

Faculty

Diana Childers, MD
Patricia Juang, MD
Grace Bacani, FNP
Kurt Pfeifer, MD, FACP, SFHM, DFPM
Leonard Feldman, MD, FACP, FAAP, MHM

Faculty Disclosures
The faculty and planners of these activities have no relevant relationships to disclose. All relevant relationships were mitigated prior to the start of this activity.

Conflict of Interest Disclosure Policy
In accordance with the ACCME Standards for Commercial Support, SHM requires that individuals in a position to control the content of an educational activity disclose all relevant financial relationships with any commercial interest. SHM mitigates all conflicts of interest to ensure independence, objectivity, balance, and scientific rigor in all its educational programs. All relevant financial relationships shall be disclosed to participants prior to the start of the activity.

Furthermore, SHM seeks to verify that all scientific research referred to, reported, or used in a continuing medical education (CME) activity conforms to the generally accepted standards of experimental design, data collection, and analysis. SHM is committed to providing its learners with high-quality CME activities that promote improvements in healthcare and not those of a commercial interest.

Accreditation Statement
The Society of Hospital Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

CME Credit Statement
The Society of Hospital Medicine designates this online activity for a maximum of 2.00 AMA PRA Category 1 Credit^TM. Physicians should claim only credit commensurate with the extent of their participation in the activity.

MOC Credit Statement
Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 2.00 MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program. Participants will earn MOC points equivalent to the amount of CME credits claimed for the activity. It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.

Managing Diabetes and Hyperglycemia in the Hospital: Focus on the Noncritically Ill Patient

Hospitalized patients with diabetes require specific medical management in order to minimize the risk of hyperglycemia. This requires hospitalists to have an understanding of methods for glycemic control in both the critically ill and noncritically ill patient. This activity, which focuses on the noncritically ill patient, is part of a 2-part series that will evaluate the current scientific evidence regarding glycemic control and discuss which medications are best for controlling blood glucose levels in the hospital. A thorough discussion of how to determine the appropriate insulin dose and develop an insulin regimen for hospitalized patients is provided, as well as strategies for developing a discharge plan for patients on insulin.

Multiple Credits

$0.00 - $95.00

SHM Consults Core Curriculum

Hospitalists are the fastest growing portion of the physician work force. Some estimate there will be 50,000 hospitalists needed in the next 10 years. As the number of hospitalists grows, so too will the clinical settings in which we practice. Consultative medicine is a service provided by many hospitalists, and a future in which almost all surgical patients are co-managed by hospitalists is already a reality for some. For many of us, our training in consultative medicine during residency was limited. We hope this curriculum will help you to feel more confident about your knowledge and skills and will lead to better patient outcomes. We welcome your comments and suggestions for future topics.

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Perioperative Evaluation and Treatment of Adrenal Insufficiency

Surgery in patients with primary adrenal insufficiency can precipitate acute adrenal insufficiency, a potentially life-threatening complication. Acute adrenal insufficiency, however, can be prevented by the perioperative administration of a short activity of stress dose steroids. Patients with secondary adrenal insufficiency due to exogenous steroid administration may also be at risk for perioperative acute adrenal insufficiency due to suppression of the hypothalamic-pituitary-adrenal axis. When these patients present for preoperative evaluation, the risk for acute adrenal insufficiency must be weighed against the risk of administering higher steroid doses in the perioperative period. Inconsistencies in the published literature and the widespread use of perioperative dexamethasone can make decisions about perioperative stress dose steroid administration challenging. The following activity suggests a rational strategy for the perioperative management of both patients with known adrenal insufficiency and those at risk for hypothalamic-pituitary-adrenal axis suppression due to exogenous steroid administration.

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Evaluation and Management of Cirrhosis in the Perioperative Setting

Patients with cirrhosis who undergo surgery are at increased risk for complications. Perioperative morbidity and mortality vary depending on the severity of cirrhosis, type of surgery, and whether it is elective or emergent. Identification of cirrhosis and accurate assessment of severity can be challenging but is necessary for case selection, informed consent, and anticipation of potential complications. Inaccurate risk assessment can sometimes lead to inappropriate exclusion of patients with cirrhosis from receiving useful surgery, as well. For instance, reliance on the Child-Pugh score alone likely significantly over-estimates perioperative mortality in patients with cirrhosis undergoing most procedures. This activity identifies updated tools for perioperative risk prediction, outlines the most important elements of preoperative evaluation and optimization, and assists in formulation of pre- and postoperative care plans for patients with cirrhosis. Though our main focus is on cirrhosis, we will also touch on some important topics related to other acute and chronic liver disease.

Multiple Credits

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Perioperative Management of Anticoagulant Therapy

Anticoagulant medications are commonly prescribed to patients in the United States for a number of medical problems. Interruptions in anticoagulation can result in severe adverse outcomes, including permanent disability and death, from arterial and venous thromboembolism. These medications can also be associated with serious perioperative bleeding events. In fact, both bleeding and thromboembolic risks are amplified in the periprocedural period. Many patients undergo routine and emergent procedures, thus it is critical for hospitalists, who are routinely asked to manage medically complex surgical patients, to understand the periprocedural management of anticoagulation. There are many nuances to consider: not all patients are at the same risk of thromboembolism, not all procedures are associated with the same risk of bleeding, and the indications for “reversal agents” are complex. This activity will guide the participant on the perioperative timing of anticoagulant interruption, the potential need for perioperative bridging anticoagulation, and address these nuances to better equip hospitalists for managing perioperative reversal.

Multiple Credits

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Perioperative Medication Management

Although general internists and subspecialists are familiar with prescribing and managing medications in typical outpatient and inpatient venues, the perioperative period represents a challenging and often unfamiliar setting. This activity will outline the principles, available evidence, and expert opinion to be considered when making perioperative management recommendations for some of the most commonly prescribed medications.

Multiple Credits

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Perioperative Infections and Fever

Perioperative fever has multiple possible etiologies, including infections such as pneumonia, fungal infections, central-line associated infections, and urinary infections. By understanding the typical time frame and common risk factors for each etiology, hospitalists and other perioperative consultants can develop a differential diagnosis for perioperative fever. The following activity will provide a general approach for determining the differential diagnosis in patients with a perioperative fever, as well as an outline of the diagnostic and treatment modalities.

Multiple Credits

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Anesthesia for Internists

The goal of anesthesia is to facilitate a surgical procedure both for patient and surgeon. Not only does an anesthesia team relieve and prevent pain and anxiety due to surgical procedures, but it also expedites the conduct of procedures and optimizes surgical conditions by preventing patient movement and ensuring hemodynamic stability. While some procedures require a small amount of sedation, others require general anesthesia and/or regional anesthesia. This activity discusses the basic types of surgical anesthesia as well as the indications and contraindications for each. Additionally, the most commonly used medications will be reviewed, including mechanism of action and side effects. An overview of the American Society of Anesthesiologists Physical Classification Status System is presented along with considerations that may prompt an anesthesiologist to delay or cancel a surgical procedure.

Multiple Credits

$0.00 - $95.00