ManagementofHyperglycemiaintheCriticalCareSetting.pptVIP

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ManagementofHyperglycemiaintheCriticalCareSetting.ppt

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ManagementofHyperglycemiaintheCriticalCareSetting

* * * * * * * * * * * * * * * * * * * * * * * * * * * * Additional Questions to Consider When Converting to SC Insulin Is the patient eating? If so, what and when? What are the concomitant therapies? Glucocorticoids? Inotropes? Vasoconstrictors? Will resolution of the illness(es) or change in concomitant therapies reduce insulin needs? * Calculating the SC Insulin Dose Establish the 24-hour insulin requirement by extrapolating from the average intravenous insulin dose required over the previous 6-8 hours (if stable) Take 60%-80% of the total daily dose (TDD) Give one-half as an intermediate-acting or long-acting insulin for basal coverage Give other half as a short-acting or rapid-acting insulin in divided doses before meal Umpierrez G, et al. J Clin Endocrinol Metab. 2012;97:16-38. * OTHER PUBLISHED STUDIES FOR CONVERSION FROM IV TO SC * Bode: Transition From IV Insulin Infusion to SC Insulin Therapy Example: Patient has received an average of 2 U/h IV during previous 6 h. Recommended doses are as follows: SC TDD is 80% of 24-h insulin requirement: 80% of (2 U/h x 24) = 38 U Basal dose is 50% of SC TDD: 50% of 38 U = 19 U of long-lasting analogue Bolus total dose is 50% of SC TDD: 50% of 38 U = 19 U of total prandial rapid-acting analogue or ~6 U with each meal Correction dose is actual BG minus target BG divided by the CF, and CF is equal to 1700 divided by TDD: CF = 1700 ÷ 38 = ~40 mg/dL Correction dose = (BG - 100) ÷ 40 Bode BW, et al. Endocr Pract. 2004;10(suppl 2):71-80. BG, blood glucose; CF, correction factor; IV, intravenous; SC, subcutaneous; TDD, total daily dose. * DeSantis: Transition From IV Insulin Infusion to SC Insulin Therapy Example 1: Conversion from intravenous insulin therapy Intravenous insulin drip rate averaged 1.8 U/h with final glucose level 98 mg/dL Calculate average insulin infusion rate for last 6 h = 2.1 U/h and multiply x 24 to get total daily insulin requirement(2.1 x 24 = 50 U/24 h) Multiply this 24-h dose (50 U) x 80% to obta