Question

Management of hyperglycemia in hospitalized patients.

Hint:

Effective glucose management requires close monitoring and individualized insulin therapy to reduce the risk of complications during hospitalization.

Answer 1

Managing hyperglycemia in hospitalized patients is crucial for preventing complications, such as infections, delayed wound healing, and poor overall recovery. Hyperglycemia is common in both diabetic and non-diabetic patients during hospitalization due to stress, infection, and medications.
Step 1: Monitoring Blood Glucose Levels:
1. Frequent Blood Glucose Testing: Blood glucose should be monitored frequently, especially in patients with known diabetes, those receiving corticosteroids, or patients with acute illness. Target glucose levels should be individualized, but general targets are 140-180 mg/dL for most hospitalized patients.
2. Continuous Glucose Monitoring: In critically ill patients, continuous glucose monitoring may be used for more accurate and timely adjustments.
Step 2: Insulin Therapy:
1. Basal-Bolus Insulin Regimen: A basal-bolus insulin regimen, which includes long-acting insulin for basal coverage and short-acting insulin for meal-related spikes, is commonly used in hospitalized patients.
2. Sliding Scale Insulin: A sliding scale insulin regimen can be used as a supplementary approach, though it is often less preferred compared to the basal-bolus regimen. It involves adjusting insulin doses based on the patient's current blood glucose level.
Step 3: Adjusting for Underlying Conditions:
1. Acute Illness: In cases of acute illness or surgery, insulin requirements may change due to stress hormones or medications. Insulin therapy should be adjusted accordingly to manage fluctuations in glucose levels.
2. Discontinuing Medications: Drugs such as corticosteroids, which can elevate blood glucose, should be carefully monitored. If possible, non-glucose-elevating alternatives should be considered.
Step 4: Education and Long-Term Management:
1. Post-Discharge Care: Patients should be educated on proper glucose monitoring and insulin use upon discharge to prevent readmissions related to poorly controlled diabetes.