INPATIENT DIABETES MANAGEMENT

 

Created by: Oren Steen (PGY3, Medicine) and Dr. Rene Wong (Division of Endocrinology)

 

We hope that you will find the following information helpful while you manage patients with diabetes on the wards.  Please feel free to direct any questions or feedback to Oren Steen (oren.steen@utoronto.ca) or Dr. Wong (Rene.Wong@uhn.on.ca).

 


 

TOPICS

 

   WARD ISSUES 

    New Diagnosis

   Assessing Glycemic Control

   Hyperglycemia on Oral Agents

   Insulin Initiation

   Insulin Titration

   Creating Sliding Scales

   Adjusting Insulin or Oral Agents in the NPO Patient

   Perioperative/IV Insulin

   Insulin Pharmacokinetics

   Insulin Prescription

 

   CALLS FROM THE WARD

 Hypoglycemia

 Hyperglycemia

 Should I Hold this Medication?

 

   ER ASSESSMENTS

   Diabetic Ketoacidosis/Hyperosmolar Hyperglycemic State

   New Diagnosis of Diabetes

 Hypoglycemia

 


 

 References

1.   Canadian Diabetes Association 2008 Clinical Practice Guidelines for the Prevention and Management of Diabetes in CanadaCan J Diab.  2008; 32: S10-S74. .        

2.   Cheng A. and Fantus G. Oral Antihyperglycemic Therapy for Type 2 Diabetes Mellitus. CMAJ. 2005;172(2):213-224

3.   Cheng A.  Perioperative Glycemic Control: What is the Evidence?  Endocrinology Rounds. 2002;2(3):1-6

4.   Inzucchi S. Management of Hyperglycemia in the Hospital Setting. NEJM. 2006;355(18):1903-1910

5.   Kitabchi AE et al. Hyperglycemic crises in adult patients with diabetes: a consensus statement from the American Diabetes Association. Diab Care. 2006; 29:2739.

6.   Kitabchi AE et al. Thirty Years of Personal Experience in Hyperglycemic Crises: Diabetic Ketoacidosis and Hyperglycemic Hyperosmolar State.  JCEM.  2008; 93:1541-1552

7.   Mooradian A et al. A Rational Approach to Starting Insulin Therapy. Ann Intern Med. 2006;145(2):125-133

8.   Rohlfing CL et al. Defining the Relationship Between Plasma Glucose and HbA1c, Analysis of glucose profiles and HbA1c in the Diabetes Control and Complications Trial,

      Diabetes Care 25:275-278, 2002

9.   Segal P.  Unpublished manuscript.  2009.

10. Stoner GD.  Hyperosmolar Hyperglycemic State.  Am Fam Physician. 2005; 71(9):1723-1730.

 

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