| Diabetes Care in the Hospital |
Insulin is preferred method for glycemic control in the hospital setting
- Exclusive use of SSI is strongly discouraged
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Recommendations for diabetes care of patients in the ICU (critical care):
- Intravenous insulin shown to be the best method for achieving glycemic targets
- Administer using validated written or computerized protocols that allow for predefined adjustments in infusion rate based on glycemic fluctuations and insulin dose
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Recommendations for diabetes care of patients in noncritical care settings:
- Scheduled subcutaneous insulin injections that align with meals and bedtime*
- Insulin regimen with basal, nutritional, and correction components (basal-bolus) for individuals with good nutritional intake
- Basal plus correction insulin regimen for individuals with poor oral intake or who are NPO
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| The safety and efficacy of noninsulin therapies are being studied |
| *Or every 4-6 hrs if no meals or if continuous enteral/parenteral therapy being used |
| Glycemic Targets for Critically Ill Individuals |
| Insulin is the preferred method for achieving glycemic control for diabetes care in the hospital |
Recommendations for critically ill individuals with persistent hyperglycemia:
- Initiate insulin starting at ≤180 mg/dL (10.0 mmol/L)
- Once insulin is started, a target glucose range of 140-180 mg/dL (7.8-10.0 mmol/L) is recommended for most patients
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More stringent targets may be appropriate for certain patients providing a lower target does not confer increased hypoglycemia risk
- 110-140 mg/dL (6.1-7.8 mmol/L)
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A hypoglycemia management protocol should be established for each patient:
- A plan for prevention and treatment of hypoglycemia should be developed
- All episodes of hypoglycemia should be documented and tracked
- The treatment plan should be reviewed and changed when glucose is <70 mg/dL (3.9 mmol/L)
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| Glycemic Targets for Noncritically Ill Individuals |
- Glucose target of 140-180 mg/dL (7.8-10.0 mmol/L) is recommended for most
- A lower target (<140 mg/dL) may be appropriate for individuals with a prior history of successful tight glycemic control and who are clinically stable
- Higher ranges may be appropriate for individuals who are terminally ill, have severe comorbidities, or are in in-patient care settings where frequent glucose monitoring is not feasible
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| Recommendations for Perioperative Care |
Target glucose range for perioperative period:
- 80-180 mg/dL (4.4-10.0 mmol/L)
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| Perioperative risk assessment for individuals at high risk for ischemic heart disease and those with autonomic neuropathy or renal failure |
| On the morning of the procedure, withhold OADs and give half of the NPH dose or full doses of long-acting analog or pump basal insulin |
| Monitor blood glucose every 4-6 hours while NPO and dose with short-acting insulin as needed |
