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American Diabetes Association
1701 North Beauregard Street
Alexandria, Virginia 22311
DOI: 10.2337/9781580406086
Library of Congress Cataloging-in-Publication Data Names: Draznin, Boris, editor. | American Diabetes Association, issuing body. Title: Managing diabetes and hyperglycemia in the hospital setting / Boris Draznin, editor. Description: Alexandria : The American Diabetes Association, [2016] | Includes bibliographical references and index. Identifiers: LCCN 2015045525 | ISBN 9781580406086 (alk. paper) Subjects: | MESH: Hyperglycemia—therapy. | Diabetes Mellitus—therapy. | Hospitalization. | Hyperglycemia—prevention & control. Classification: LCC RC660.7 | NLM WK 880 | DDC 616.4/62—dc23 LC record available at http://lccn.loc.gov/2015045525
Contents
Contributors
Preface
Introduction
Chapter 1 The Evolution of Glycemic Control in the Hospital Setting E. Moghissi and S. Inzucchi
Chapter 2 The Diagnosis and Classification of Diabetes in Nonpregnant Adults I.B. Hirsch and L.M. Gaudiani
Chapter 3 Perils of Glycemic Variability and Rapid Correction of Chronic Hyperglycemia S.S. Braithwaite and I.B. Hirsch
Chapter 4 Insulin Errors in the Inpatient Setting R. Hellman
Chapter 5 Food, Fasting, Insulin, and Glycemic Control in the Hospital M. Korytkowski, B. Draznin, and A. Drincic
Chapter 6 Glycemic Control in the Setting of Parenteral Nutrition or Enteral Nutrition via Tube Feeding C.C. Low Wang, R.M. Hawkins, R. Gianchandani, and K. Dungan
Chapter 7 Steroid-Associated Hyperglycemia N. Mathioudakis, K. Dungan, D. Baldwin, M. Korytkowski, and J. Reider
Chapter 8 Transitioning from Intravenous to Subcutaneous Insulin L.F. Lien, C.C. Low Wang, K. Evans Kreider, and D. Baldwin, Jr.
Chapter 9 Preoperative, Intraoperative, and Postoperative Glucose Management R. Gianchandani, E. Dubois, S. Alexanian, and R. Rushakoff
Chapter 10 Treatment of Hyperglycemia on Medical and Surgical Units R.J. Rushakoff, H. Windham MacMaster, M. Falciglia, and K. Kulasa
Chapter 11 Hospital Glucose Management of Post-Transplant Patients A. Sadhu, A. Kansara, U. Masharani, D. Baldwin, R. Rushakoff, and A. Wallia
Chapter 12 Hyperglycemia in Patients Undergoing Hematopoietic Stem Cell Transplantation S.J. Healy, B. Draznin, and K.M. Dungan
Chapter 13 Management of Hospitalized Adult Patients with Cystic Fibrosis–Related Diabetes B. Draznin and R. Gianchandani
Chapter 14 Improving the Safety and Effectiveness of Insulin Therapy in Hospitalized Patients with Diabetes and Chronic Renal Failure J. Apel and D. Baldwin
Chapter 15 Insulin Resistance in Patients Treated with Therapeutic Hypothermia and in Patients with Severe Burns B. Draznin, K. Dungan, and S. Seggelke
Chapter 16 Inpatient Management of Patients with Extreme Insulin Resistance Receiving U-500 Insulin A. Diesburg-Stanwood, N. Rasouli, and B. Draznin
Chapter 17 Management of Patients Postpancreatectomy S. Kim, B. Draznin, and R.J. Rushakoff
Chapter 18 Inpatient Management of Patients with Diabetes after Bariatric Surgery S. Alexanian and I.Lingvay
Chapter 19 Emergency Department Management of Diabetes Patients with Non-crisis Hyperglycemia M.F. Magee, C.M. Nassar, J.J. Reyes-Castano, and M.E. McDonnell
Chapter 20 Diabetic Gastroparesis: Update with Emphasis on Inpatient Management J. Calles-Escandón, K.L. Koch, B. Draznin, and A. Drincic
Chapter 21 Inpatient Management of the Pregnant Woman with Diabetes E.O. Buschur, M.E. McDonnell, M.K. Figaro, and E.M. Eggleston
Chapter 22 Diabetic Ketoacidosis and Hyperglycemic Hyperosmolar State J.S. Haw, R. Rushkoff, and G.E. Umpierrez
Chapter 23 Hypoglycemia Prevention and Treatment J.L. Gilden, D.J. Rubin, K. Kulasa, and G. Maynard
Chapter 24 Use of Continuous Subcutaneous Insulin Infusions in the Inpatient Setting: A Guide to Management E. Faulds, R. Rushakoff, U. Masharani, and K. Dungan
Chapter 25 Continuous Glucose Monitoring in the Hospital P. Peter and S.E. Inzucchi
Chapter 26 Noninsulin Therapies C.E. Mendez, R.Y. Gianchandani, and G.E. Umpierrez
Chapter 27 Patient Education K. Rodriguez, L. Meneghini, J. Jeffrie Seley, and M.F. Magee
Chapter 28 Nursing Education J. Jeffrie Seley, M.F. Magee, and R.J. Rushakoff
Chapter 29 Resident Education R.J. Rushakoff, C. Low Wang, J. Jeffrie Seley, and A.L. Warnock
Chapter 30 Transition of Care: Discharge from the Hospital D.J. Rubin, L.F. Meneghini, J. Jeffrie Seley, E. Cagliero, L.M. Gaudiani, and J.L. Gilden
Sara Alexanian, MD
Jill Apel, MD
David Baldwin, Jr., MD
Susan S. Braithwaite, MD
Elizabeth O. Buschur, MD
Enrico Cagliero, MD
Jorge Calles-Escandón, MD
Amy Diesburg-Stanwood, DNP, FNP-BC
Boris Draznin, MD, PhD
Andjela Drincic, MD
Elizabeth Dubois, PA-C
Kathleen Dungan, MD, MPH
Emma M. Eggleston, MD
Kathryn Evans Kreider, DNP, APRN, FNP-BC
Mercedes Falciglia, MD, FACP
Eileen Faulds, CNP, CDE
M. Kathleen Figaro, MD
Linda M. Gaudiani, MD, FACP, FACE
Roma Gianchandani, MD
Janice L. Gilden, MS, MD, FCP, FACE
J. Sonya Haw, MD
R. Matthew Hawkins, PA-C, MMSc
Sara J. Healy, MD
Richard Hellman, MD, FACP, FACE
Irl B. Hirsch, MD, MACP
Silvio E. Inzucchi, MD
Jane Jeffrie Seley, DNP, MSN, MPH, GNP, BC-ADM, CDE, CDTC
Abhishek Kansara, MD
Sarah Kim, MD
Kenneth L. Koch, MD
Mary Korytkowski, MD
Kristen Kulasa, MD
Lillian F. Lien, MD
Ildiko Lingvay, MD, MPH, MSCS
Cecilia C. Low Wang, MD
Michelle Magee, MD, MBBCh, BAO, LRCPSI
Umesh Masharani, MD
Nestoras Mathioudakis, MD
Greg Maynard, MD, MSc, SFHM
Marie E. McDonnell, MD
Carlos E. Mendez, MD, FACP
Luigi F. Meneghini, MD, MBA
Etie Moghissi, MD, FACE
Carine M. Nassar, MS, RD, CDE
Patricia Peter, MD
Neda Rasouli, MD
Jodie Reider, MD
John J. Reyes-Castano, MD
Kellie Rodriguez, MSN, MBA, CDE
Daniel J. Rubin, MD, MSc, FACE
Robert J. Rushakoff, MD
Archana Sadhu, MD, FACE
Stacey Seggelke, RN, MS, CDE
Guillermo E. Umpierrez, MD
Amisha Wallia, MD
Alicia Lynn Warnock, MD, FACP
Heidemarie Windham MacMaster, PharmD, CDE, FCSHP
As the number of patients with diabetes, both diagnosed and as yet undiagnosed, increases annually, it is not surprising that the number of patients with diabetes who are admitted to the hospital also increases. The prevalence of overt diabetes is estimated to exceed 30% among individuals who are 60 years of age and older. Because individuals in this age-group account for a large number of hospital admissions for a variety of medical and surgical conditions, even conservative estimates suggest that ~25 to 30% of all hospitalized patients on any given day in any given hospital in the U.S. have diabetes. The percentage of hospitalized patients outside the U.S. who have diabetes is likely to show the same trend.
Even though patients with diabetes may be admitted to the hospital with acute or chronic complications of diabetes, most frequently they are hospitalized for other medical and surgical problems and their diabetes becomes a significant comorbidity that may affect the outcome of their hospitalization. Moreover, patients with prediabetes or undiagnosed diabetes are frequently hyperglycemic either on admission to the hospital or in the course of their hospital stay, adding to the complexity of their medical or surgical problems. The treatment of diabetes and hyperglycemia in these situations requires the utmost attention and specialized knowledge.
Once in the hospital, patients with diabetes or hyperglycemia may be admitted to the intensive care unit, require urgent or elective surgery, enteral or parenteral nutrition, intravenous insulin infusion, and therapies that have a significant impact on glycemic control (e.g., steroids). Because many clinical outcomes are profoundly influenced by the degree of glycemic control, knowledge of the best practice in inpatient diabetes management assumes paramount importance.
In the twenty-first century, in most U.S. community hospitals, hospitalist physicians provide medical care to these patients. In some hospitals, particularly academic and other tertiary care hospitals, hospitalists share this task with endocrinologists. A small number of hospitals have established specialized glycemic (diabetes) management teams led by either a physician or a mid-level provider, such as a nurse practitioner or a physician assistant, to help control blood glucose levels in hospitalized patients. These teams prove to be of great importance not only for successful management of patients with diabetes, but also for diabetes education of patients, nursing staff, and house staff.
The field of inpatient management of diabetes and hyperglycemia has grown substantially in the last several years, accumulating and disseminating important clinical knowledge. This body of knowledge is summarized in this book, so it can reach the audience of hospitalists and endocrinologists, both in practice and in training—the very physicians who take care of hospitalized patients with diabetes and hyperglycemia.
Boris Draznin, MD, PhD, Editor
The Celeste and Jack Grynberg Professor of Medicine
University of Colorado School of Medicine
The Management of Diabetes and Hyperglycemia in the Hospital Setting: A Practical Guide
As the number of patients with diabetes, both diagnosed and as yet undiagnosed, increases annually, it is not surprising that the number of patients with diabetes who are admitted to the hospital also increases. The prevalence of overt diabetes is estimated to exceed 30% among individuals who are 60 years of age and older. Because individuals in this age-group account for a large number of hospital admissions for a variety of medical and surgical conditions, even conservative estimates suggest that ~25 to 30% of all hospitalized patients on any given day in any given hospital in the U.S. have diabetes. The percentage of hospitalized patients outside the U.S. who have diabetes is likely to show the same trend.
Even though patients with diabetes may be admitted to the hospital with acute or chronic complications of diabetes, most frequently they are hospitalized for other medical and surgical problems and their diabetes becomes a significant comorbidity that may affect the outcome of their hospitalization. Moreover, patients with prediabetes or undiagnosed diabetes are frequently hyperglycemic either on admission to the hospital or in the course of their hospital stay, adding to the complexity of their medical or surgical problems. The treatment of diabetes and hyperglycemia in these situations requires the utmost attention and specialized knowledge.
Once in the hospital, patients with diabetes or hyperglycemia may be admitted to the intensive care unit, require urgent or elective surgery, enteral or parenteral nutrition, intravenous insulin infusion, and therapies that have a significant impact on glycemic control (e.g., steroids). Because many clinical outcomes are profoundly influenced by the degree of glycemic control, knowledge of the best practice in inpatient diabetes management assumes paramount importance.
In the twenty-first century, in most U.S. community hospitals, hospitalist physicians provide medical care to these patients. In some hospitals, particularly academic and other tertiary care hospitals, hospitalists share this task with endocrinologists. A small number of hospitals have established specialized glycemic (diabetes) management teams led by either a physician or a mid-level provider, such as a nurse practitioner or a physician assistant, to help control blood glucose levels in hospitalized patients. These teams prove to be of great importance not only for successful management of patients with diabetes, but also for diabetes education of patients, nursing staff, and house staff.
The field of inpatient management of diabetes and hyperglycemia has grown substantially in the last several years, accumulating and disseminating important clinical knowledge. This body of knowledge is summarized in this book, so it can reach the audience of hospitalists and endocrinologists, both in practice and in training—the very physicians who take care of hospitalized patients with diabetes and hyperglycemia.
