Management of hyperglycemia in inPts

(for ICU: see “Sepsis”) (Clin Ther 2013;35:724)

• Hyperglycemic Emergencies (Endocrinology)

• Identify reversibl causes/precipitants (dextrose IVF, glucocorticoids, postop, ↑ carb diet)

• Dx studies: BG fingersticks (fasting, qAC, qHS; or q6h if NPO), HbA1C

• Treatment goals: avoid hypoglycemia, extreme hyperglycemia (>180 mg/dL)

• Transition to inPt: T1D: do not stop basal insulin (can → DKA) T2D: stopping oral DM meds generally preferred to avoid hypoglycemia or med interaction (except if short stay, excellent outPt cntl, no plan for IV contrast, nl diet). If Pt on insulin as outpt do not rely on sliding scale alone (Diabetes Care 2022;45:S244).

• Starting new insulin regimen Basal = 0.2–0.4 U/kg/d NPH Q12h or detemir or glargine + correction insulin for BG >150 mg/dL + prandial insulin if eating: 0.05–0.1 U/kg/meal lispro, aspart, or regular

• When NPO T1D: continue basal insulin at current dose or 75% depending on BG control T2D: continue basal insulin at 25–75% depending on BG control and level of insulin resistance. Hold all prandial insulin.

• Discharge regimen: similar to admission regimen unless poor outPt cntl or strong reason for Δ. Arrange early insulin and glucometer teaching, prompt outPt follow-up.