Glycemic Control
I. Considerations
- For insulin-naive patients, basal insulin (glargine) should be ordered to begin on hospital day 2 after glucose checks
- If BG remains <180, consider continuing only sliding scale insulin (SSI)
- Basal insulin should not be held if the patient is NPO
- All patients with insulin orders should also have the Adult Hypoglycemia Management order set
- Use caution in:
- Renal dysfunction
- Elderly patients
- Patients on glucocorticoids
- Large volume fluid shifts
- Discontinue sliding scale and glucose monitoring if:
- Glucose remains <150 mg/dL for 24 hours
- Patient is on goal diet
II. Choice of Sliding Scale
- Patients without DM:
(BG - 100) / 50
- DM on 1–2 oral meds or GLP-1 agonists:
(BG - 100) / 30
- DM on >2 oral meds or insulin at home:
(BG - 100) / 20
- DM on insulin and A1c >9%:
(BG - 100) / 15
III. Insulin Infusion
- If glucose >250 mg/dL despite maximal sliding scale administration:
- Consider transfer to SICU for intensive glucose management
- Refer to SICU Glycemic Control Guideline
IV. Indications for Endocrinology Consultation
- Type I Diabetes Mellitus
- Use of concentrated insulin U-500 at home
- Use of insulin pump at home
- Discharge recommendations/follow-up in patients with:
- New DM diagnosis and A1c > 6.5%
- Known DM with A1c > 9%
V. References
- Yendamuri S, et al. J Trauma. 2003;55:33–38
- Laird A, et al. J Trauma. 2004;56:1058–1062
- Sung J, et al. J Trauma. 2005;59:80–83
- Van den Berghe G, et al. N Engl J Med. 2001;345:1359–1367
- NICE-SUGAR Investigators. N Engl J Med. 2009;360:1283–1297
- Jacobi J, et al. Crit Care Med. 2012;40:3251–3276
- Mowery NT, et al. J Trauma. 2010;68:342–347
- Mowery NT, et al. World J Surg. 2011;36:270–277
- Krinsley J, et al. Crit Care Med. 2008;36:3008–3013
- Kauffmann RM, et al. JPEN. 2011;35:686–694
- Bode BW, et al. Endocr Pract. 2004;10(2):71–80
VI. Authors
- Michael J. Derickson, MD
- Kelli Rumbaugh, PharmD, BCPS, BCCCP
- Jade Flynn, PharmD, BCPS