Donner said, “often times the housestaff will write sliding scale insulin orders regardless of whether the patient is on insulin or not.” “If a patient comes into the hospital,” Dr.
Nevertheless, he said that the approach used at many hospitals is woefully inadequate. “There are many obstacles to achieving good blood sugar control in these patients.” “When you think of managing diabetes, you think it’s really hard to do, and it can be,” he told the hospitalists at the meeting. He noted that some of the more obvious challenges include high levels of cortisol in inpatients, unpredictable eating times and little to no physical activity. Donner acknowledged that tightly controlling the glucose levels of hospitalized patients is not always easy. Donner outlined some easy-to-use strategies to implement a standardized glucose regimen that will better control your inpatients’ glucose levels.ĭr. He also pointed to research that has found that sliding scale insulin, an approach that is still common at many hospitals, leads to more hyperglycemia and hypoglycemia.ĭuring the meeting, which was held in cooperation with Today’s Hospitalist magazine, Dr. Donner said that countless studies have shown that poorly controlled glucose is associated with many problems, from infections to mortality. In a presentation on inpatient diabetes management at the Fall 2005 Hospitalist CME Series, Dr. The surgery went smoothly, but when she was discharged from the ICU to the wards on sliding scale insulin only, she experienced ketoacidosis, lengthening her hospital stay by several days.Īccording to Thomas Donner, MD, director of the Joslin Diabetes Center at the University of Maryland School of Medicine, the above case, which involved one of his patients, illustrates a simple but critical point: For many diabetics admitted to the hospital, sliding scale insulin doesn’t do an adequate job of controlling glucose. The patient had a long history of type 1 diabetes, but the condition had always been well-controlled, in part because she was very diligent about her diabetes care.
While the patient was admitted to the hospital with chest pain and ended up needing bypass surgery, the real trouble came in managing her diabetes. Published in the January 2006 issue of Today’s Hospitalist
0 kommentar(er)
