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Inpatient Diabetes Management

9 snips
Jun 26, 2020
Dr. Nadine Palermo, an endocrinologist and Associate Director of the Acute Diabetes Care program at Brigham and Women’s Hospital, shares her expertise on managing diabetes in hospitalized patients. She discusses the importance of identifying hyperglycemia types and customizing treatment plans based on individual patient factors. Dr. Palermo also delves into the use of both insulin and emerging non-insulin agents, emphasizing tailored weight-based dosing strategies. Discover how effective management can significantly influence patient outcomes during hospital stays.
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INSIGHT

Three Groups of Hyperglycemia

  • There are three groups of hyperglycemic patients in hospitals: established diabetes, undiagnosed diabetes, and stress hyperglycemia.
  • Dysglycemia during acute illness increases hospital complications, healthcare use, and mortality risk.
ADVICE

Prefer Insulin over Oral Agents

  • Generally, stop non-insulin agents and use insulin as the main therapy for inpatient diabetes.
  • Consider risks of oral agents like metformin, sulfonylureas, TZDs, and SGLT2 inhibitors when hospitalized.
ADVICE

Weight-Based Insulin Dosing

  • Start hospital insulin dosing with a weight-based approach, usually 0.5 units/kg/day split 50% basal and 50% prandial.
  • Add correctional/sliding scale insulin to manage glucose above targets.
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