Glucose Management University of Colorado Hospital

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Glucose Management University of Colorado
Hospital

• Bridget Everhart, MSN, NP, CDE, CCRN
• Inpatient Diabetes Educator
• Bridget.Everhart_at_uch.edu MF Pager 303
  266 -7898

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UCH Diabetes Program

• Michael McDermott MD Diabetes Program Director
• Carolee Whitehill RN MS Diabetes Program
  Administrator
• Advisory Committee
• Michael McDermott MD
• Reenie Zaccardi RN MSN NP
• Mary Krugman RN PhD FAAN
• Steve Ringel MD
• Carolee Whitehill RN MS
• Bridget Everhart Inpatient Diabetes Educator
• Jenny Madrid Outpatient Diabetes Education
  Coordinator
• Connie Zachrich Clinical Data Specialist

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SCOPE

• 25 of Inpatients
• DM diagnosis
• Hyperglycemia
• Pregnancy with DM or GDM
• 5000 Outpatients
• Primary Care Endocrine

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Inpatient Diabetes Educator

• Program Development
• Order sets, data collection, revisions
• Staff Education
• Patient Education high risk patients
• Clinical Recommendations

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Target BG Goals

• ADA Standards of Care for DM Jan 09
• CC Surgical close to 110 and generally lt140mg/dL
• CC Non Surgical lt 110 140mg/dL
• Non CC fasting lt126mg/dL generally
  lt180-200mg/dL
• June 2009 AACE ADA Inpatient Consensus
• CC Start insulin at no greater than 180mg/dL
• Goal 140-180mg/dL
• Non CC Pre-meal lt140mg/dL Random lt180mg/dL
• UCH IV Insulin Infusion (CC Committee)
• 120 150mg/dL

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Unit-Based Glycemic Report Example
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Glucose Management Practices

• NO Regular insulin Sliding Scale (SSI)
• Use Basal / Bolus insulin
• (ie 24hr basal insulin rapid acting insulin)
• UCH Formulary Insulins
• Glargine, Lispro, 70/30, Regular
• Avoid Orals Inpatient
• Order A1C - assess control and for d/c planning
• Diabetes Meal Plan order diabetes AND calories
  a

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Insulin Orders

• Main Order sets
• SQ Glargine / Lispro
• SQ NPH / Lispro
• SQ Insulin for TPN Tube Feedings
• IV Insulin Infusion
• Additional Insulin Order Sets
• Continuous Subcutaneous Insulin Infusion (CSII)
  Pumps. Also see the detailed policy
• DKA / HHS orders have a different IV Insulin
  Infusion
• IV Insulin Infusion for LD
• Intensive SQ Insulin Orders used in OB

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Insulin Orders Basal Glargine

• ORDER GLARGINE (Lantus)
• ? ___ units Glargine subcutaneous in abdomen at ?
  0800 daily OR ? 2200
• OR
• ? Patients weight ___kg x 0.2 units ____units
  Glargine subcutaneous in abdomen at ? 0800 daily
  OR ? 2200 daily
• Total Daily Dose of insulin is best allocated as
  50 long acting and
• 50 rapid acting for most patients

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Insulin Orders Lispro for Meals AND Correction
Insulin Sensitive 151 CI on 45gm/meal 501
Correction, BG goal 100
Insulin Resistant 101 on 60gm/meal 251
Correction, BG goal 100
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Insulin Pump Patients (CSII)

• Keep pump inpatient if patient AO, able to
  operate it
• Consult Glucose Management Team
• ORDERS and CONSENT required
• Patient keeps BG records
• If pump removed give IV or SQ insulin
• See detailed policy online

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Resources UCH DM website

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Glucose Mgt Review Screen
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Glucose Management Team

• Consultant providers 24/7
• See on call schedule for pager
• ALL insulin pump patients
• Any other pts - e.g. DKA/HHS, Type 1, steroids,
  cyclic TPN, BGs hard to control