Endocrine: Inpatient DM & Hyperglycemia

FBG >/= 126 or random >/= 200 and confirmed after hospitalization

OR

HgbA1c > 6.5%

Any BG > 140 during hospitalization that normalizes after discharge

<70

<40

• Glucocorticosteroids
• Vasopressors
• Octreotide
• Thiazides
• Atypical antipsychotics
• Protease inhibitors

Maintain 140-180

(<110 not recommended)

• FBG < 140
• Random < 180

Basal/bolus 50/50 strategy as T1DM

Avoid bolus in NPO pts

DKA or non-ketotic hyperosmolar state

Surgical pts

Organ transplantation

AMI or cardiogenic shock

Stroke

• Exacerbated hyperglycemia 2^o to glucocorticoid Tx
•   
• NPO status in type 1 DM

Critically ill patients (esp. w/ mech. vent.)

Sudden NPO status or PO reductions

Enteral feedings or TPN D/C'd

Pre-meal insulin given and meal not ingested

Unexpected transport after bolus

Reduction in corticosteroid dose

D/C of med that causes hyperglycemia

15g carbs (4 oz juice/soda, 8oz non-fat milk, 3-4 glucose tabs)

25-50 mL D50 IV push

finger stick q15m and repeat if <80