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28 Cards in this Set
- Front
- Back
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What the short-term risks associated with hyperglycemia in the hospital setting
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increased srik fo complication, mortaility and a long hospital stay, and high admission rate to ICU
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What is the MOA of hyperglycemia in the acute setting
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increases in counteregulatory hormones due stress which results in alterations in carb metabolism, insulin resistane, and increase hepatic glucose production, and release of inflmattory mediators
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What are glucose goal for in-patients for fasting and random glucose glucose according to ADA
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FBG 90-130
Random BG <180 |
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What are the 3 components for GENERAL treatment for hospitized pts
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Basal insulin
Nutritional Insulin Correction dose insulin (based on insulin senstivity) |
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1/2 of TDD insulin is secretetd as a basal function, and 1/2 is secreted due to nutrtional intake!, when correctional dose insulin given
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correct hypergylcemia that occurs depiste the basal and nutrtional insulin
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Basal insulin (glargine or detemir) shoould be provided when
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ALWAYS be proved, even when the person is NOT eating
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Can you use NPH is a pts who is NPO event though it peaks
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YES--however should recduce dose
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Who should be given nurtional insulin (rapid acting aspart, glulisine, and lispro)
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patient who are eating meals or bolus tube feeding
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What is the con of using regular insulin for nutrtional insulin
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must be given 30 minutes before meal--problem with nursing usints
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Patient who are NOT recieving any nuration should NOT receive
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nurtional insulin
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What type of insulin is usually used for correctional dose
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SAME as the nutrtional insulin
RAPID acting Could be regular |
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When is correctional dose insulin usually given
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SAME time as the nurtional insulin
or every 4-6 hours if patietns are NOT |
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If a correction dose insulin is required consistently or in high dose--what is needed
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modifiction to the basal and or nurtional insulin
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As a general rule what is a conservating starting point for TDD of insulin in MOST patients
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0.4 units/kg--TDD
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When sould a LOWER insulin dose of 0.3 units/kg be STARTED (INSULIN SENSITIVE PT
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ELDERLY patients or patient with CrCL <60
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What can be a TDD started in obses pats or patients receiving corticosteriod (INSULIN RESISTANT)
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0.5 units/kg
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How should insulin be given in patient eating meal
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Basal insulin 50% of TDD (Glargine qd)
and nutrtional insulin 50%--divided equally into 3 meals and given with means Correctional before every meal and qHS |
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How should insulin be given if patient NOT eating
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50% TDD of Basal insulin
Correction insulin q4 hours (RAA) NO NUTRTIONAL insulin b/c NOT eating |
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What patients can CONTINUE the HOME regimen in the hopsital
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CLINICALLY STABLE, normal nurtional intake, NORMAL BG values,a dn stable renal and cardic function
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What is the MAIN disadvantage of continuing the home regimen in the hopital
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difficult to quickly tirate to effect
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Sliding Scale insulins IS NOT recommend as monothearpy, wht
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it is more reactive strategy that treat hyperglycemia after its already occur does not PREVENT
and we that hyperglycemia is assoicted with increased risk of complictions,and long hostpials and mortaility |
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What is the preffered use of IV insulin
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for the ICU
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What is the preferred use of SUBQ inuslin
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NON-crtically ill patients
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What makes the Basal/Bolus reigmen the ideal reigmen for treatment of hyperglycemia
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acts rapids, mimics normal physiologic insulin
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What are some cons of the Basal bolus reigmen
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matching insulin based pts variable can be difficult, more time consuming the SSI
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When should you be monitoring BG
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before each meal and at bedtime
or every 6 hours in pts that NOT eating Signs/Symptoms of Hypoglycemia |
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FOr patients with BG <70 how do treat if paitnet is alert
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ORAL intake of 20g of carb (6 oz of fruit just or soda or cracks), and check every 20 minutes and repeat until BG >70
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What are important componets of education for discharge
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SMBG, adminstiration, hypogylcemia both recognition and treatment, glycemic goals, and education about sick day treatments
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