Info

Are his blood glucose readings within target? What questions would you askEP? Has a pattern been established?

You ask EP to remove his shoes and socks and you perform a foot screening. Why did you do this? Why is it important to record the results of the foot screening?

Does EP need to be referred to any specialists? If so, what type?

What nonpharmacologic interventions would you recommend for EP?

Are his blood pressure and lipids under control? Would you make any adjustments to therapy, and if so, specifically what?

Before

After

Before

Breakfast

Greakfast

Lunch

Mon

IIS Í&5)

Tue

122 (6.8)

Wed

13-1 QA)

Thur

110(6.1)

l~ri

98 {5.1}

Sat

12Ê (7.1)

Sun

116 (6.4}

Hospitalized Care

Aggressive treatment of hyperglycemia in hospitalized patients can prevent unnecessary cost to patients and health care systems. When patients are either physically or emotionally stressed, counterregulatory hormones are released, increasing blood glucose levels.

Insulin drip therapy for patients with blood glucose levels greater than 140 mg/ dL (7.8 mmol/L) is considered superior to sliding-scale insulin. Sliding-scale insulin therapy typically lags the blood glucose level instead of proactively addressing the increased blood glucose levels. Blood glucose levels can be measured by several methods. Arterial samples are usually 5 mg/dL (0.28 mmol/L) higher than capillary values and 10 mg/dL (0.56 mmol/L) greater than venous values.

When preparing an insulin infusion for a patient, several factors must be considered. Insulin will absorb to glass and plastic, reducing the amount of insulin actually delivered by 20% to 30%. Priming the tubing will decrease variability of insulin infused. Therefore, when patients can be converted safely from infusion to needle and syringe therapy, the total daily dose should be reduced by 20% to 50% of the daily infusion amount.

When transferring someone from IV insulin drip to subcutaneous insulin, basal insulin should be administered several hours before the drip is discontinued to prevent loss of glycemic control. IV drip protocols are institution specific and will not be discussed. Hospitals may apply to receive a Certificate of Distinction for Inpatient Diabetes Care sponsored by the Joint Commission and the ADA.43

Sick Days

Patients should monitor their blood glucose levels more frequently during sick days because it is common for illness to increase blood glucose values. Patients with T1DM should check ketones when their blood glucose levels are greater than 300 mg/dL or higher. This may need to be done every 1 to 2 hours and additional insulin coverage

may be necessary to prevent DKA. Sugar and electrolyte solutions such as sports drinks may be used by T1DM patients to prevent dehydration, electrolyte depletion, and hypoglycemia. Insulin treated patients with longstanding T2DM may also require ketone testing on sick days. Patients with T2DM may require sugar-free products if blood glucose levels are elevated consistently. Patients should be advised to eat smaller meals if possible during sick days to decrease nausea and maintain blood glucose control. With proper management, patients can decrease their chance of illness-induced hospitalization.

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