Endocrine Abstracts

Introduction and objectives: Hyperglycemia is present in about 25% of hospitalized patients. His control is common deficient. Consequently it increases the average stay, infection rates and mortality. In order to improve we present a comprehensive protocol.

Methods: We developed algorithms of subcutaneous insulin therapy for non-critical patients, insulin therapy i.v. for critical patients, management of hypoglycemia, fasting situations, diabetic ketoacidosis/hyperosmolar state, and performance at hospital discharge.

Results: 1. Subcutaneous insulinization for patient not critical. Patient previously with insulin: basal/24 h (glargine/detemir) + bolus(glulisine/lispro/aspart) breakfast, lunch and dinner + correction bolus a(<40u), b(40–80u), c(>80u). Patient previously within insulin: regular insulin regimen breakfast/lunch/dinner/6–8 h in fasting. >16u/24 h pass to basal-bolus-correction. Fasting: *<24 h: suspend bolus and maintain basal + bolus correction *> 24 h: serum-insulina i.v./6 h.

2. Insulin i.v. for critical patient. 1. fluid line: glucosaline 5% 60–100 ml/h±1.2 meq/kg of clk. Insulin line 2: saline 0.9% 100 ml with 100 u regular insulin. Insulin infusion (ml/u/h) by patterns 1, 2, 3, 4 based on blood glucose and variation. Transition to subcutaneous insulin: insulin last 6 h×4, 50% basal insulin – 50% bolus insulin, maintain perfusion three hours after putting basal insulin.

3. Management of hypoglycemia (<70 mg/dl). Patient conscious and can ingest: 200 ml water with two sugar packets. Patient unconscious or unable to ingest: 10 g glucose (i.v.) or glucagon 1 mg (sc/im). Repeat procedure if blood sugar below 70 mg/dl in 15 min.

4. Diabetic ketoacidosis and hyperosmolar state. 1. fluids: 1000 ml 0.9% saline/1 h, after 250–500 ml/h. When glucose <200 mg/dl glucosaline 5% 100–150 ml/h. 2. insulin: 0.1 u/kg of regular insulin bolus directly. i.v. insulin infusion beginning with pattern 2. 3. potassium: k<3.3 meq/l: 20 meqk/500 ml, k3,3–5,3 meq/l: 10 meqk/500 ml. K>5.3 meq/l: not manage. 4.bicarbonate: if ph <7% half deficit administer 1/6 m in 4–6 h and revaluate.

5. Performance at hospital discharge. Apply for hba1c if not available in last three months. Dm known and hba1c <8%: pretreatment. Dm unknown or hba1c>8%: initiate/intensify treatment.

Conclusions: We believe that this protocol will contribute to better management of blood glucose by different professionals in hospitalization. It remains to evaluate their impact after his introduction.