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


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.