How to manage Diabetes in patients admitted to the hospital ? By Dr Om J Lakhani
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- Опубліковано 5 лип 2024
- In this informative video, Dr. Om J Lakhani, a renowned endocrinologist, provides an in-depth discussion on the management of diabetes in hospitalized patients.
- [00:00]( • How to manage Diabetes... ) 🏥 Introduction and definitions.
- Defines hospital hypoglycemia as a blood glucose reading more than 140 mg/dl.
- Explains three various situations: known diabetes, newly diagnosed diabetes, and stress hypoglycemia (no prior diabetes but blood glucose over 140).
- [02:18]( • How to manage Diabetes... ) 🎯 Setting the target for blood glucose control.
- The target for ICU patients is 140 to 180 mg/dl.
- For non-ICU settings, the target for fasting blood sugar is less than 140, and post meal sugar should be less than 180.
- [04:50]( • How to manage Diabetes... ) 👀 Review of landmark studies and shifting guidelines.
- Discusses various studies that have influenced the blood glucose control targets in ICU settings.
- Mentions that future guidelines may accept blood glucose between 140 to 215 mg/dl
- [06:56]( • How to manage Diabetes... ) ❌ The critique of sliding scale insulin treatment.
- Criticizes the use of sliding scale insulin due to its reactive nature and propensity to cause damage from constantly fluctuating blood glucose levels.
- Suggests the approach should be more proactive in maintaining steady blood glucose levels.
- [09:37]( • How to manage Diabetes... ) 💉 Use of IV Insulin in ICU.
- Discusses how IV insulin is administered in ICU settings based on different blood sugar readings.
- Asserts that maintaining a steady state of blood glucose is necessary to improve outcomes in both ICU and non-ICU settings.
- [13:04]( • How to manage Diabetes... ) 💦 Guiding the use of IV Fluids.
- Provides guidance on administering IV fluids based on different levels of blood glucose.
- [14:13]( • How to manage Diabetes... ) ⏱ The transition from IV insulin to subcutaneous insulin.
- Discusses conditions under which a patient can switch from IV insulin to subcutaneous insulin, including stable blood sugar of less than 180 for 4 to 6 hours, normalization of the anion gap, etc.
- Explains how to calculate the required dosage based on insulin given over the last 6 hours.
- [17:31]( • How to manage Diabetes... ) 🔄 Switching from IV to Subcutaneous Insulin.
- Explains step by step, how to switch a patient from receiving IV insulin to subcutaneous insulin based on some calculations.
- [20:49]( • How to manage Diabetes... ) 📝 Example of the transition Calculation.
- Gives an example of how to practically calculate the transition from IV insulin to subcutaneous insulin.
- [22:36]( • How to manage Diabetes... ) 💉 The calculation for transitioning patients from IV to subcutaneous insulin in non-ICU settings
- Introduces the insulin calculation for transitioning patients from IV to subcutaneous insulin
- Outlines a specific prescription example: "insulin reba 10 units at 7 p.m and short-acting insulin FAS divided into three equal doses."
- [23:27]( • How to manage Diabetes... ) 🩸 Recommendations for blood sugar monitoring in non-ICU patients
- Suggests it is typical to monitor patient's blood sugar four times a day in most cases.
- States that in some cases, blood sugar is monitored six times a day.
- [24:24]( • How to manage Diabetes... ) 🚨 Addressing Diabetic Emergencies
- Highlights the importance of monitoring potassium levels during diabetic emergencies.
- Suggests that dehydration can be common during these conditions and therefore fluid replacements may need to be aggressive.
- [25:06]( • How to manage Diabetes... ) 📚 Introducing Lani Kumar's formula for starting insulin regime in non-critically ill patients
- Introduces the Lakhani-Kumar formula for calculating a starting insulin dosage for non-critically ill patients.
- Utilizes fasting blood sugar to estimate the basal dose of insulin.
- [27:13]( • How to manage Diabetes... ) 🔄 How to adjust insulin doses in a non-ICU patient
- Discusses the method of adjusting a patient's insulin dose based on their morning fasting blood sugar level.
- Describes the calculation of insulin-sensitivity factor (ISF) and uses it to adjust the insulin dose.
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In patient on basal bolus, if we check pre lunch sugar and its 220 which is 80 more than target shud we increase pre breakfast dose for next day as 220 pre lunch is indicative of insufficient pre breakfast dose.
Yes . Provided the carbohydrate content of the breakfast is consistent in the hospital mean which it should
Thanks sir!@@EndocrinologyIndia
Thanks alot doctors ❤
Thanks so much..i have question regarding patient on ng feeding how to calculate dosage of insulin
Will share a video on special situations
Mainly if patients on NG feeding formula...Thakyou so much
Thank you sir. Pls make more such videos!
Absolutely. Most welcome
Sir How to calculate total dose of insulin in Non critically ill patient
Please see the other video on mathematics of insulin dosing on the same channel.
16:15 after RBS 310 .. why add +1 instead of +0.5 ?
Why not (3.1+0.5) = 3.6 ml/hr
Well you can . However this is as per the Yale protocol .
RSSDI 2016 thresholds for non ICU glucose targets are vague, what is ( premeal below 140 and post-meal below 180 mg/dl), is it 80-----140 or 100----140, or 110---140 or 80-----180 or 100----180,or 140-----180. Also saying that ICU target up to 215 mg/dl is odd.
Yes RSSDI guidelines on this are outdated
@ 26:10. Can you share the reference in which article Holman Turner discussed this formula pl .
Strange P. Treat-to-target insulin titration algorithms when initiating long or intermediate acting insulin in type 2 diabetes. Journal of Diabetes Science and Technology. 2007 Jul;1(4):540-8.
Strange P. Treat-to-target insulin titration algorithms when initiating long or intermediate acting insulin in type 2 diabetes. Journal of Diabetes Science and Technology. 2007 Jul;1(4):540-8.
Sir, if prelunch glucose is above target, which dose of insulin we will increase ? Is it prelunch or prebreakfast regular insulin or evening long acting insulin ?
For that day you will give a higher prelunch dose of short acting- the next day you will either increase the dose of basal insulin or the dose of prebreakfast insulin the next day
@@EndocrinologyIndia 🙏