Hospital Care of Diabetic Patients

Achieving diabetic control under normal ambulatory conditions is difficult enough in most patients. When illness prevents a patient from utilizing diabetic survival skills, however, and the stress of illness overcomes the patient's available insulin, care of the patient becomes a professional challenge. In the past, lack of data often resulted in less-than-optimal diabetic care in favor of managing the primary illness. Recent observations, however, demonstrate the efficacy of glycemic control in critically ill surgical patients. As a result, intensive glucose management protocols with continuous insulin infusion are now being widely applied. Good glucose control in known diabetic patients and those with marked hyperglycemia and critical illness shortens intensive care unit (ICU) and respirator time and reduces associated polymyopathy while generally improving all outcome parameters. Many post-cardiothoracic surgery units have adopted these protocols to improve myocardial "energetics," limit infection, and discharge the patient sooner.

Similar studies of glycemic control have not been definitive in critically ill patients with sepsis to GI bleeding, although these varying diagnoses may have created methodologic issues. Thus, professional societies are recommending that critically ill patients be maintained with glucose levels less than 140 mg/dL (ADA, 2009). These therapeutic goals seem reasonable, until therapeutic methodology improves to limit hypoglycemia, which adversely affects outcomes associated with intensive insulin treatment protocols.

Diabetes 2

Diabetes 2

Diabetes is a disease that affects the way your body uses food. Normally, your body converts sugars, starches and other foods into a form of sugar called glucose. Your body uses glucose for fuel. The cells receive the glucose through the bloodstream. They then use insulin a hormone made by the pancreas to absorb the glucose, convert it into energy, and either use it or store it for later use. Learn more...

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