Indoor management of diabetes
Journal Title: Journal of the Indian Medical Association - Year 2018, Vol 116, Issue 3
Abstract
Hyperglycemia in indoor patients is defined as any blood glucose >140 mg/dl 1 and are further classified as: hyperglycemia in previously diagnosed/known diabetes; previously undiagnosed diabetes/ diagnosed upon admission. Hyperglycemia is most common in critically ill patients especially stress hyperglycemia. It is recommended to start intensive intravenous insulin therapy with shortacting regular human insulin or rapid acting insulin analog, preferably using an infusion pump in critically ill. Basal bolus is the preferred regimen and if well controlled on pre-mixed insulin in non critically ill. The discharge plan in diabetes should begin well before the discharge to ensure smooth transition of care between hospital and home. Those on insulin should be educated for insulin injection rotation technique, site rotation, frequency of self-monitoring of blood glucose, insulin dosage adjustments to achieve glycemic targets and hypoglycemia management. There are no pre-requisites for perioperatively. A stable glycemic control prior to the elective procedure with HbA1c target of <8% (corresponding to mean plasma glucose of 180 mg/dl) is acceptable. Maintenance of target blood glucose levels during labour and delivery requires a balanced administration of insulin and glucose preferably in the form of separate infusions.
Authors and Affiliations
Robin Maskey
Keywords
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