Inpatient Diabetes Management

A summary of the inpatient management of diabetes. Topics include the sliding scale, basal bolus regimens, adjusting insulin when NPO, adjusting insulin for persistent hyperglycemia, and the consistent carb diet.

Information here is provided for educational purposes only, and is not intended to substitute for the opinion of an experienced and licensed health care professional.

[StrongMed]

...The bolus dose is meant to prevent post-prandial hyperglycemia from developing after the meal, while the sliding scale dose is meant to treat the hyperglycemia already present going into the meal.

[romeolhk]

This video is pure gold, the example at the end connects everything up, thankyou for the amazing lecture!

[StrongMed]

If the pre-dinner sugar is 260, then using the example sliding scale from the video, you would give the patient a one time additional 6 units of short-acting insulin added to whatever was scheduled for the bolus dose. If the patient consistently (i.e. more days than not) has an elevated pre-dinner sugar, a modest increase of the AM basal dose (if on NPH) would be appropriate.

[sudiptapal]

Sir, please make more such videos! Need faculties like you who can spread light on how to do inpatient management. It's really very necessary. Most of us are deprived of such quality education. These are the things I yearn for. So please make more such videos! Absolutely loved this video of yours! I hope that u make many more in the future.!

[mukizarogers]

This is the best video on DM management I have ever watched. Thank you Eric for being a blessing to us.

[marciamacielsantiago]

Thank you so much! I am an IMG already in residency in Canada who has finished medical school 15 years ago! Your lectures really inspired me!

[thegasdoc]

Awesome video.. Don't understand how Dr. Eric presents such complex topics such lucidly

[StrongMed]

icemanaxs, both great questions. First, in the RABBIT 2 trial, the basal bolus regimen actually included a sliding scale. In other words, both arms of the trial received a sliding scale, with one arm receiving nothing in addition, and the other receiving the basal bolus in addition. So optimally, for a patient on a basal bolus regimen (which actually is basal/long-acting + bolus/scheduled + s.s.), the premeal insulin should be the scheduled bolus dose plus the amount according to the s.s.

[ethancrispell]

Thank you so much! About to start my inpatient internal medicine med school rotation and diabetes management has been a black box for me up until this point.

[sunving]

thank you Dr Strong, i seem to pick up more from second time listening . Thanks very much.

[mujeebrahman]

sir your lectures are simple and so easy to understand.
great effort

[plexiformnucleus]

you are the best, Dr. Strong. Thank you.

[icemanaxs]

Thank you for the quick reply and for clearing up my doubts regarding inpatient diabetes treatment.
All your videos have been very helpful to me, in fact i'm just going through your current lecture series on antibiotics, keep up the good work.

[StrongMed]

There aren't guidelines per se ("official" guidelines on inpatient diabetes control are relatively vague, consistent with our lack of definitive knowledge of the subject), however references that suggest TDD of 0.3 u/kg/d for the elderly include Metabolism 62:326-36 (PMID 22999713) and Endocrinol Metab Clin North Am 41:175-201 (PMID 22575413). There are others as well, but these are among the most recent.

[eddy]

As an intern, this is an excellent presentation

[RickC--flcv]

If youTube have given out Emmeys this video would have definitely won a one!!

[arundhir]

This was extremely well done. Thank you Dr. Strong.

[luigimeneghini]

I very much the clarity with which you present this topic. Some of the adjustments in insulin therapy I would have done differently, such as possibly increasing the pre-lunch insulin dose to correct pre-dinner hyperglycemia in the example cited. Also, if the basal dose should maintain blood glucose levels stable when there is no exogenous glucose entry (i.e. in the fasting state); as such I would generally maintain the same basal dose if the patient is placed NPO for a short period of time (i.e. has sufficient glycogen stores to maintain hepatic glucose output). For adults with type 1 diabetes the usual outpatient insulin dose ranges between 0.4 to 0.7 units/kg/day; I am concerned that while a 0.3 u/kg/day recommendation will definitely prevent hypoglycemia, it may not be sufficient to control hyperglycemia in many of them. For those with type 1 diabetes that do well self-managing their diabetes, I would favor letting them maintain control of their insulin regimen in the in-patient setting as long as there is no significant cognitive or physical impairment to doing so.

[bongbun]

I never leave any comments on youtube, but thank you for your hardwork! Lots of love ❤️❤️❤️

[rishikeshjoshi]

Very clearly elucidated. Could you please point out if there are any changes seven years later?