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Inpatient glycemic management
Lecture 12
18
Pharmacology
Professional
09/30/2012

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Cards

Term
How is diabetes newly diagnosed?
Definition
FBG > 126
Random BG > 200
A1C > 6.5
Can be hospital related, reverts to normal after discharged.
Term
Why is glucose higher in the hospital or infection?
Definition
Stress response increases glucose, decreases insulin
- Increased reactive oxygen, immune dysfunction
- Leads to increased cell injury, acidosis
- A NEW hyperglycemia patient will have a longer hospital stay
Term
How does blood sugar affect mortality?
Definition
If BG > 150, mortality increases significantly.
Term
What are the goals for ICU and non-ICU patients?
Definition
- Critical (ICU) patients goal 140-180, closer to 140 better for the patient.
- Non-critical (non-ICU) goal <140 fasting, random goal <180. Consider modifying if BG<100, required if <70
Term
What do studies say about ICU patients w/ diabetes?
Definition
Intensive care (BG goal 80-110) decreases morbidity and mortality. No difference seen in-hospital death, but benefits seen in discharge
Term
What does the NICE-SUGAR trial say?
Definition
Unexpected result - tight glucose control increases risk of death. The reason why goal is a RANGE rather than specific.
Term
What do trials say about non-ICU patients?
Definition
There are no trials about non-ICU patients
Term
What is the therapy of choice for ICU and non-ICU patients?
Definition
ICU - insulin infusion. IV regular insulin, not analogs
Non-ICU - SQ insulin
Preferred therapy is always insulin. Oral agents disliked.
Term
What are concerns about using oral agents in the hospital?
Definition
- time to reach steady state
- AEs
- administration w/ food absorption
Term
What are clinical pearls on SUs (secretagogues) in the hospital?
Definition
ALWAYS watch renal function b/c eliminated by kidneys
- Glyburide - ACTIVE metabolites, do not recommend for use
- Glipizide - mostly inactive, renally excreted
- Glimepiride - 2C9 active metabolite
Ischemic preconditioning
Term
What are clinical pearls about metformin in the hospital?
Definition
- Risk of lactic acidosis: CHF, hypoperfusion due to damage, renal insufficiency (hold for contrast dye), older age, COPD
- GI discomfort
Term
What are clinical pearls for TZDs in the hospital?
Definition
- Rosiglitazone associated with ischemic events
- Edema common
- Delay in onset, not good in the hospital
Term
How is IV insulin dose determined?
Definition
50% of home regimen divided over 24 hours
Term
What are the components of non-ICU therapy
Definition
- Basal - rapid + long acting
- Nutritional - may be a meal or IV
- Supplemental/Correction - corrects for high readings
If type 1, will need all 3. sickness increases insulin demand.
Term
What insulin is used for hospital basal dosing?
Definition
Insulin glargine/Lantus QPM, check BG in the morning. or Levemir in place of Lantus
Term
Which insulins are used for nutritional insulin options?
Definition
Short acting insulins such as novolog before meals (TID), or humalog
Lag times:
- BG 80-99 lag time 0
- BG 100-199 lag time 10-20
- BG 20-299 lag time 20-30
- BG >300 lag time 30-40
Term
What insulins are used for correction?
Definition
Never use regular insulin, always use an analog
1500 (regular) or 1800 (analog) / total daily insulin = sensitivity factor. Use rapid acting analogs.
Term
When are insulin pumps used?
Definition
Patients and providers are familiar with use and dosing
- Bolus dosing: 500/total insulin = carb ratio
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