Hospital Management of Diabetes
Treatment of Hypoglycemia
Acute: give 1 amp of D50
Hospital Management of Home Oral Medications
Unless a patient a short-stay with no real acute medical issues discontinue home medications while the patient is in the hospital. The two most common outpatient medications for diabetes are metformin and sulfonyureas. Metformin should not be used in patient’s whose creatinine is above 1.5. Patients in the hospital often have changing renal function from fluid status, IV contrast or nephrotoxic medications. Sulfonyureas carry a risk of hypoglycemia if the patient is not eating. Patient in the hospital often need to be made NPO without advance warning.
Metformin: Risk of lactic acidosis
· Contraindications for metformin during hospital stay
o Kidney dysfunction
o Radiographic studies with IV contrast dyes
o Surgery
o Hepatic disease
Sulfonyurea: Risk of hypoglycemia
· Contraindications for sulfonyurea during hospital stay
o Changing renal function
o Patient who are going to be made NPO
Controlling BG with Insulin
Types of Insulin Used
Long-acting (usually given once a day at night)
Baseline (a set amount of insulin given before meals)
Sliding Scale (insulin given before meals to decrease high glucose levels)
Targets Levels
Prepandial: < 110
Peak postprandial: < 180
SICU: 80-110
Determining Insulin Requirements
Type 1 DM: 0.6 U/kg
Type 2 DM: 0.7 U/kg
Determining Correction Insulin
Correction Factor = Total Calories in Diet per Day/ Total Daily Insulin Dose
The correction factor will tell you how much one unit of insulin will correct for a reading above 150.
Carb Counting
500/Total Daily Insulin Dose = Number of carbs covered by 1U of insulin
The 500 Rule:
· Estimates grams of carb per unit of Humalog or Novolog insulins (the 450 Rule is used with Regular insulin)
· 500 divided by your TDD (Total Daily Dose of insulin) = grams of carb covered by one unit of Humalog or Novolog
1 serving of carbohydrate = 15g
Typically there are 3-5 servings at each major meal and 1-2 servings at snacks.
Starting an Insulin Regimen
Take total insulin dose and give 50% as lantus and 50% as novolog divided among each meal as a baseline.
preprandial AM glucose is a measurement of lantus level
preprandial lunch and dinner is a measurement of baseline meal level
Adjusting Insulin
Adjusting from day to day
· If some BGs were < 80 use 80% of yesterdays dose
· If some BGs were >180 and none <80 use 110% of yesterday’s dose
Diabetes type 1
Have an absolute requirement for insulin. Lantus is the pancreas. Do not stop for NPO.
Sliding scale should be loose 1,2,3,4,5…
Writing a Sliding Scale
Use correction factor to write a sliding scale order