Insulin Task Force Updates

Quick Start Basal-Bolus Insulin Badges

Posted on Sep 1, 2012 in Insulin Task Force Updates | Comments Off on Quick Start Basal-Bolus Insulin Badges

The Insulin Task Force monitors blood glucose determinations throughout the hospital, and there has been a disturbing trend.  Our goal blood glucose range is 70 to 180.  Within the past year on the Summit campus, the percentage of blood glucose determinations within that range has dropped from 66 percent to 63 percent, and on the Ashby campus it has dropped from 67 percent to 58 percent.

Blood sugar control tends to be better in the ICUs, with the Summit campus reaching goal range in the critical care units 73 percent of the time and 70 percent of the time on the Ashby campus.  Physicians are encouraged to utilize the insulin pre-printed orders, which conform to the recognized standards of insulin administration of basal bolus insulin.

The task force has also developed a “Quick Start Basal-Bolus Insulin” badge, which can be affixed to our ID badges.  This badge contains the essential information for commencing basal-bolus insulin on inpatients and suggests appropriate dosing.  These badges can be obtained from Marilyn Barkin, R.N., at the Summit Case Management Office on the ground floor.

Data are emerging that patients with stress-induced hyperglycemia with no prior history of diabetes have equal to or greater morbidity and mortality than similar diabetic patients with similar degrees of hyperglycemia. Such patients with stress-induced hyperglycemia should be treated as diabetics, and similar blood sugar goals need to be applied to this population.

The “Diabetes Update” in this newsletter is the second in our series of diabetes case studies.

Diabetes Update

Posted on Sep 1, 2012 in Insulin Task Force Updates | Comments Off on Diabetes Update

Header with Physicians: Glycemic Control in the Hospital: A Case-Based Team Approach

Alta Bates Summit Medical Center

Case of the Month

A 45-year-old woman with type 1 diabetes on insulin pump therapy (0.1 units an hour basal rate and 1 unit per 15 g carbohydrate nutritional coverage) was seen in the ED for weakness and confusion.

She was admitted to the hospital to r/o a stroke. Her BG was 125 when her insulin pump was removed in the ED at 10 a.m. She was started on correctional Novolog insulin Q4 hours. She ate lunch with no coverage.

Four hours later when her BG was checked on the stroke unit her BG was 375.

What went wrong?

This patient is insulin dependent. She has no basal insulin since the pump was removed and did not have nutritional coverage at her last meal. Without additional insulin added, this patient would most likely go into DKA.

Disaster averted:

The nurse caring for the patient administered the correctional Novolog, and she contacted the physician for nutritional and basal insulin to be added to the patient’s insulin regimen and for finger stick BG testing to be changed to before meals and HS.

The MD changed the finger stick testing to before meals and added four units of nutritional Novolog at mealtime and 24 units of Lantus insulin at HS.                      2 Needlesticks Testing Instruments

GO TEAM!!!!

Test your Knowledge About Type 1 Diabetes

1. The onset of type 1 diabetes always occurs before the age of 20.

____ true ____ false

2. Type 1 patients with blood sugar <100 at HS may not need their p.m. dose of Lantus insulin.

____ true ____ false

3. Before a type 1 patient who is treated for hyperglycemia or DKA can be taken off of an insulin drip, they must be given a dose of SQ basal insulin.

____ true ____ false

For additional information, please contact Ann Doherty, Alta Bates Summit Diabetes Center manager, at 510­-204­-2508.

Answers: 1. False: the majority of cases are <30 years old and are not obese, but type 1 diabetes may occur at any age and any weight. 2. False: type 1 patients are insulin dependent and must have their basal and bolus insulin on board to prevent ketosis. 3. True! IV insulin only stays in the system about seven minutes. SQ basal insulin­ Lantus is usually given two hours before stopping an insulin drip and nutritional/correctional Novolog given as needed to cover meals and hyperglycemia.

First Edition Case Studies from Insulin Task Force

Posted on Jul 1, 2012 in Insulin Task Force Updates | Comments Off on First Edition Case Studies from Insulin Task Force

Diabetes Update Glycemic Control: Case Study and TestAnswers:  1. true, 2. false, 3. true, 4. true, 5. true