Skip to main content

SICK DAYS- SITUATIONS REQUIRING HOSPITALIZED CARE!

SITUATIONS REQUIRING HOSPITALIZED CARE

  • The NICE-SUGAR (Intensive versus conventional glucose in critically ill patients) trial compared intensive (81-108 mg/dL) with conventional glucose control using IV Insulin in 6104 intensive care unit patients.
  • At 90 days, intensively controlled patients had an increased absolute risk of death of 2.6%.
  • Significantly, more hypoglycemia was observed in intensively controlled group.

Recommendations:

  • Current recommendations call for critically ill patients to be started on IV Insulin therapy at a threshold of 180mg/dL.
  • A goal range of 140-180mg/dL is recommended for majority of patients.
  • More stringent goals may be considered for selected critically ill patients, but only if hypoglycemia can be avoided.
  • Scheduled SC insulin regimens with basal, nutritional and correction components are recommended for patients who are not critically ill.
  • Goals of less than 140mg/dL for fasting glucose and less than 180mg/dL for random glucose are recommended for non-critically ill patients.

  • Patients should monitor their blood glucose levels more frequently during the sick days because it is more common for illness to increase blood glucose values.
    • Patients with T1 DM should check their glucose and urine for ketones every 4 hours when sick.
    • Patients with T2 DM may also need to check for ketones when their blood glucose levels are greater than 300mg/dL.
    • Patients should continue to take their medications while sick.
    • T1 DM patients may require additional insulin coverage, and some with T2 DM who are currently on, or medication regimens may require insulin during an acute illness.
    • Patients should be advised to maintain their normal caloric intake and carbohydrate intake while ill as well as to drink plenty of non-caloric beverages to avoid dehydration.
    • When having difficulty eating a normal diet, patients may be advised to use non-diet beverages, soft drinks, broths, crackers, soup, and non-diet gelatins to provide normal caloric and carbohydrate intake and avoid hypoglycemia.
    • With proper management, patients can decrease their chances of illness-induced hospitalization, particularly Diabetic Ketoacidosis & Hyperosmolar Hyperglycemic State.

    Measurement of Blood Glucose Levels:

    Several methods can be used for measuring Blood glucose levels.

    • Arterial samples are usually 5mg/dL higher than capillary values and 10mg/greater than venous values.
    • When preparing an insulin infusion for a patient, several factors must be considered, insulin will absorb to glass and plastic, reducing the amount of insulin actually delivered by 20%-30%. Primarily, the tubing decreases the variability of insulin infused.
    • Therefore, when patients can be converted safely from infusion to needle and syringe therapy, the total daily dose should be reduced by 20%to 50% of the daily infusion amount.
    • When transferring someone from IV insulin drip to subcutaneous insulin, basal insulin should be administered several hours before the drip is discontinued to prevent loss of glycemic control.
    • IV drip protocols are institution specific.


    Comments

    Popular posts from this blog

    Diabetes Mellitus: Non-Pharmacological Therapy--MNT!

     NON PHARMACOLOGICAL THERAPY  MNT Glycemic Index Dietary supplements Weight measurements Physical Activity Psychological assessment Immunizations 1. MEDICAL NUTRITION THERAPY (MNT)  " Medical Nutrition Therapy (MNT) is a term used by the ADA to describe the optimal condition of caloric intake with other aspects of diabetes therapy (Insulin, Exercise, Weight loss)". The ADA has issued recommendations for three types of MNT: Primary prevention measures of MNT are directed at preventing or delaying the onset of type 2 Diabetes in high-risk individuals (obese or with pre-diabetes) by promoting weight reduction. Secondary prevention measures of MNT are directed at preventing or delaying-related complications in diabetic individuals by improving glycemic control. Tertiary prevention measures of MNT are directed at managing diabetes-related complications (cardiovascular disease, neuropathy) in diabetic individuals. Despite the popular notion, there is not any " Diabetic diet...

    PNEUMONIA- Its Etiology, Pathophysiology, Classification and Severity Assessment Method!

     PNEUMONIA Definition: "Pneumonia is an infection of pulmonary parenchyma". (Harrison)                                                    OR "Pneumonia is defined as an acute respiratory illness associated with recently developed radiological pulmonary shadowing which may be segmental, lobar or multilobar". (Davidson) Etiology: Microorganisms gain excess to the lower respiratory tract in several ways: Aspiration from the oropharynx (most common). Inhalation of contaminated droplets. Hematogenous spread. Contiguous extension. Pathophysiology of Pneumonia: Pneumonia results from proliferation of microbial pathogens at the alveolar level and the hosts response to these microorganisms.  Defensive Mechanisms against Pneumonia: The defensive mechanism against pneumonia involve: Branching architecture of tracheobronchial tree. Muco-ciliary clearance. Local...

    Anatomy and the Complications Associated with Liver Diseases!

      LIVER AND THE COMPLICATIONS ASSOCIATED WITH THE PROGRESSION OF DISEASE! Liver: The liver weighs up to 1.5kg in adults and is the 2nd largest organ in the body. Hepatocytes are the functioning unit of liver. Impairment of liver may lead to: Acute liver diseases Chronic liver diseases Liver cirrhosis Acute Liver Disease (ALD): ALD is a self-limiting episode of hepatocyte damage which in most cases spontaneously without clinical sequelae, but acute liver failure (ALF) may develop. This is a rare condition in which there is a rapid deterioration in liver function with associated encephalopathy and coagulopathy. ALF carries significant morbidity and mortality and may require emergency liver transplant. Chronic Liver Disease (CLD): CLD occurs when the longstanding cell damage causes permanent structural changes within the liver, with the loss of normal liver structure and functions. In many cases, this may lead to cirrhosis where fibrosis sears divide the liver cells into areas of rege...