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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