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. 2022 Fall;35(4):420-426.
doi: 10.2337/dsi22-0012. Epub 2022 Nov 15.

Management of Hyperglycemia in the Noncritical Care Setting: A Real-World Case-Based Approach With Alternative Insulin- and Noninsulin-Based Strategies

Samaneh Dowlatshahi  1   2 , Bhargavi Patham  1   2   3 , Jawairia Shakil  1   2   3 , Maleeha Zahid  1 , Priya Arunchalam  3 , Abhishek Kansara  1   2   3 , Archana R Sadhu  1   2   3
Affiliations

Management of Hyperglycemia in the Noncritical Care Setting: A Real-World Case-Based Approach With Alternative Insulin- and Noninsulin-Based Strategies

Samaneh Dowlatshahi et al. Diabetes Spectr. 2022 Fall.

Abstract

Insulin remains the mainstay of treatment for inpatient hyperglycemia in the United States and Canada. However, some other countries commonly use noninsulin agents such as metformin and sulfonylureas, and several trials have demonstrated the efficacy and safety of incretin-based agents in patients with type 2 diabetes who are admitted to noncritical care medicine and surgery services. There is a high degree of interest in alternative glucose-lowering strategies to achieve favorable glycemic outcomes with lower risks of hypoglycemia. In this case series, we highlight the challenges of inpatient glycemic management and the need for alternatives to the traditional basal-bolus insulin regimen. Additional investigation will be imperative to validate the safety and efficacy of appropriate insulin and noninsulin treatments and to further develop guidelines that are applicable in real-world hospital settings.

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Figures

FIGURE 1
FIGURE 1
Glycemic management before and after initiation of a DPP-4 inhibitor in Case 1. Glu, glucose; HG, hemoglobin; TID/AC, three times daily before meals.
FIGURE 2
FIGURE 2
Glycemic profile with insulin dosing on continuous tube feeding in Case 2. SQ, subcutaneous; SUBQ, subcutaneously.
FIGURE 3
FIGURE 3
Glycemic profile with insulin dosing when patient was on bolus feedings in Case 2. SQ, subcutaneous; SUBQ, subcutaneously.
FIGURE 4
FIGURE 4
Glucose profile while patient in Case 3 was on PD and using an insulin pump with the following settings: basal rate: 1.6 units/hour; boluses: insulin-to-carbohydrate ratio 1:8, insulin sensitivity factor 1:50, blood glucose target 125 mg/dL; active insulin time 4 hours. The patient’s total basal insulin dose was 38.4 units. His 7-day average TDD was 62.56 units, with basal insulin accounting for 60% and bolus insulin accounting for 40%. His 14-day average TDD was 67.43 units, with basal insulin accounting for 55% and bolus insulin accounting for 45%. Glu, glucose; HG, hemoglobin; POC, point-of-care.
FIGURE 5
FIGURE 5
Glucose profile while patient in Case 3 was on HD with a subcutaneous insulin regimen. Glu, glucose; HG, hemoglobin; INJ, injection; POC, point-of-care; SQ, subcutaneous; SUBQ, subcutaneously.
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