pc5 1.9 hospitalization considerations for dm

a1c test if not done in the last 3 months, monitoring

at time of admission, what should be done for diabetic pts or pts with hyperglycemia

over 140

what blood glucose level in the hospital indicates hyperglycemia

over 6.5%

what a1c level suggest that diabetes onset occurred before hospitalization

diabetes dx, monitoring, glucose goals, s/sx of hypoglycemia/tx, meal planning, medications, when to seek help for complications

what is included is diabetes self management assessment

type, self management knowledge, consult specialized team

considerations during diabetes admission

more

(bc stress, less nutrition, decreased activity)

are hospitalized pts more or less likely for hyperglycemia

over 180 on two occasions

at what BG level should insulin therapy be initiated

140-180

once insulin therapy is started,

what is the target glucose range for most critically ill patients

100-180

once insulin therapy is started,

what is the target glucose range for non-critically ill patients

critically ill post surgery, post cardiac surgery pts

who has a BG goal of 110-140

over 250

for terminally ill pts that have a short life expectancy what is the blood glucose goal

qol, limiting dehydration, electrolyte disturbances and glucosuria

for terminally ill pts that have a short life expectancy what is the focus of treatment

prior to meals

during admission when should an eating patient's blood glucose be checked

every 4-6 hours

during admission when should a non-eating patient's blood glucose be checked

every 30 minutes to 2 hours

during admission when should a patient receiving insulin IV drip, have their blood glucose checked

venous check or POC monitoring

in the hospital how is blood glucose checked

no

(confirm with serum sample)

is venous check or POC monitoring considered the most accurate way of checking blood glucose

yes

if CGMS are used at home, should they be continued in the hospital

POCT glucose

if CGMS are used at home, and continued at the hospital, what is needed in addition

detecting hypoglycemia, decrease recurrent hypoglyecmia, improve pt satisfaction

benefits of CGMS

COVID 19

what led to more CGM use

yes

can CGMs be integrated into EHR

within 20% +/-

the 20/20 CGM says a CGM reading needs to be what when glucose is 70 or greater of the POCT measurement

within 20mg/dL +/-

the 20/20 CGM says a CGM reading needs to be what when glucose is under 70 of the POCT measurement

yes

if a patient has an automatic insulin delivery at home should that be continued in the hospital?

POCT daily testing

what needs to be done in conjuction with CGM and AID use in the hospital

continuous IV insulin infusion

in critical care setting, what is the most effective method to lower glucose

insulin

in non-critical care setting, what is the preferred method to lower glucose

with or after meal

in a non critical care setting,

if oral intake is poor, when should insulin be taken

0.3-0.6 units/kg/day

what dose is there for insulin in a non critical care setting for glucose lowering txx

patients with T2DM and CHF

in what patients should SGLT2is be continued in hospitalization

serious illness, prolonged fasting, surgical procedures

when should SGLT2is be avoided in hospitalization

no

should GLP-1RAs be continued in acutely ill pts

yes unless heart failure

should DPP4is be continued in acutely ill pts

basal insulin or basal/bolus schedule

what is preferred for glucose lowering therapy in non critically ill patients with inadequate oral intake or those with restricted oral intake

basal/bolus and correction factor

what is preferred for glucose lowering therapy in non critically ill patients with diabetes with adequate nutrition intake

before meals or every 4-6hours if no meals or continuous enteral/parenteral nutrition

when is rapid/short acting insulin used in a non critical care setting

NO

can correction or supplemental insulin be used without basal

no

(bc hypoglycemia risk)

are mixed insulins used inpatient in a non critical care setting

RN satisification

pros of insulin pens in inpatient use

multiple patient use

pros of insulin vials in inpatient use

under 70

what BG level is considered hypoglycemia inpatient

evaluate for root cause, aggregated and reviewed to address systemic issuse

what does the Joint Commission require of all hypoglycemic episodes that occur inpatient

54-69

how is level 1 hypoglycemia classified

under 54

how is level 2 hypoglycemia classified

altered mental or physical functioning requiring assistance

how is level 3 hypoglycemia classified

no

is a single meal plan endorsed for hospital nutrition

added to solution

how is insulin given in parental feeding

basal insulin

in T1DM, patients still need___ even if feedings have stopped

under 8%

what A1c goal is there before elective surgery

GMI under 8%, or TIR over 50%

what data can be used from a CGM in lieu of A1c before elective surgery

100-180

what is the target range for blood glucose before, during, and after a procedure

hold day of surgery

what is recommended for metformin use in perioperative care

discontinued 3-4 days before surgery

what is recommended for SGLT2i use in perioperative care

oral glucose lowering agents

what should be held the day of surgery/procedure

dose reduction, monitor every 2-4 hours while taking NPO, reduce basal insulin by 25% the night before surgery

recommendations for perioperative care if a patient is on insulin

reduce by half

what is the recommendation for dose reduction of NPH for perioperative care

give 75-80%

what is the recommendation for dose reduction of long acting analog for perioperative care

adjust

what is the recommendation for dose reduction of pump basal insulin for perioperative care

hold day of for daily dose or 7 days prior if weekly agent

what is recommended for GLP1RA use in perioperative care

within 4 weeks

when should follow up occur for diabetic pt after discharge

age, male, longer duration of hospitalization, number of previous hospitalizations, number/severity of co morbidities, lower SES, lower education level

risk factors for readmission of diabetic pts