Hit That Target!
When should insulin therapy be initiated for treatment of persistent hyperglycemia?
> 180 mg/dL
What is the preferred treatment for non-critically ill hospitalized patients with poor oral intake or those who are taking nothing by mouth?
Basal insulin or a basal plus correction insulin regimen
What is the blood glucose range for level 1 hypoglycemia?
<70 mg/dL and > 54 mg/dL
What is the target range for blood glucose in perioperative care?
80-180 mg/dL
What rotation are you currently on?
100 points
A non-critically ill patient presents to the med/tele floor with no comorbidities; per the ADA 2021 guidelines what is the recommended target glucose range for the majority of critically ill and non-critically ill patients?
140 – 180 mg/dL
A non-critically ill hospitalized patient with good nutrition intake is on metformin at home and is set to begin an insulin regimen, what is the preferred treatment?
Hold metformin inpatient, and begin an insulin regimen with basal, prandial, and correction components.
Level 3 hypoglycemia is characterized by _____?
Altered mental status and/or physical status requiring assistance for treatment of hypoglycemia. Can also lead to COMA OR DEATH
In parenteral feedings human regular insulin is added for blood glucose management. Why is regular insulin chosen?
Safest way to prevent hypoglycemia in these patients
You reach for a snack right now... Salty or Savory?
200 points
A patient develops level 2 hypoglycemia on your floor, what is the glucose threshold for this classification, and does it require immediate correction of glucose?
Blood glucose concentration <54 mg/dL, and yes it requires immediate correction of blood glucose.
When administering IV insulin, which type of insulin is recommended to decrease the risk of hypoglycemia?
Human regular insulin
Name 3 treatment options for a patient presenting with a blood glucose of 65mg/dL and can swallow.
4 glucose tabs, 1 can of non-diet soda, or 4 oz of juice.
What are the goals for treatment of DKA and HSS?
Restoration of circulatory volume and tissue perfusion, resolution of hyperglycemia, correction of electrolyte imbalance and acidosis
Favorite movie or TV show?
300 points
Patient BA is a 63 yo male who presents to your floor post Coronary Artery Bypass Graft surgery, what is his glycemic target and why?
Per the ADA guidelines more stringent goals such as 110 – 140 mg/dL may be appropriate for selected patients (e.g critically ill post-surgical patients or patients with cardiac surgery)
Patient EM is 65 YO patient scheduled to have a planned inpatient surgery. PMH includes T2DM and HTN. She is currently on Jardiance (empagliflozin), and metformin at home. When should each medication be held?
SGLT2 inhibitors must be discontinued 3-4 days before surgery, and metformin should be withheld on the say of surgery.
True or false? When treating hypoglycemia you should always administer treatment and then immediately check the blood glucose?
False
For patients receiving enteral nutrition, how many units of insulin should be added for a formula containing 60g of carbohydrates?
4 - 6 units
400 points
Which clinical trial showed that in critically ill patients’ intensive glycemic control (80 – 110 mg/dL) derived no significant treatment advantage compared with a group with more moderate glycemic targets (140 – 180 mg/dL)?
NICE-SUGAR (Normoglycemia in Intensive Care Evaluation and Survival Using Glucose Algorithm Regulation)
Patient KA is a 28 yo female with PMH of HTN, T2DM. She is being transferred from the ICU to the floor. Over the last 6 hours of treatment, she required 23 units of regular insulin via intravenous. When should she receive a dose of subcutaneous basal insulin and how much insulin should she receive?
The patient should receive a dose of subcutaneous basal insulin 2 hours before the intravenous infusion is discontinued. The dose of basal insulin is best calculated on the basis of the insulin infusion rate during the last 6 hours when stable glycemic goals were achieved. Therefore she would need 23 units of subcutaneous basal insulin.
KA is a 28 yo female who presents to the ED with complaints of shakiness, sweating, and fatigue. Her PMH is significant for T2DM and HTN. Upon arrival KA starts to become severely altered and is experiencing minor syncopal episodes. Her lab return with a BG value of 34mg/dL. IV access is quickly added for administration dextrose. How many grams of dextrose should KA receive and over how many minutes should it be given?
D50W (25g of dextrose) in 50mL over 1-3 minutes
TA is a 27 yo male who presents to the ED with complaints of loss of smell and taste, fever of 101.4, and headache. He has a PMH significant for Afib and HTN. COVID-19 PCR returned positive and TA was admitted for inpatient management. During his stay he was started on dexamethasone 6mg PO once daily x 10 days. You notice his blood glucose values are returning in the 200s and you decide to start him on insulin for steroid induced hyperglycemia. What insulin would you choose (dose, route, frequency)?
Lantus 10 units subcutaneously daily
What is my Kathryn's dogs name?