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- Consider hospitalizing for acute complications that cause metabolic decompensation (e.g., infections, gastroenteritis, dehydration).
- Hospitalize patients with diabetic ketoacidosis.
- Hospitalize patients with hypoglycemia and neuroglycopenia.
- Ensure perioperative glycemic control for surgical procedures.
- Consider inpatient admission to prevent and treat acute complications from contrast dye.
- Consider inpatient management for uncontrolled diabetes that cannot be regulated on an outpatient basis.
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Consider hospitalizing for acute complications that cause metabolic decompensation (e.g., infections, gastroenteritis, dehydration).  |
- Treat volume depletion and hyperglycemia aggressively, and make all attempts to prevent diabetic ketoacidosis.
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Hospitalize patients with diabetic ketoacidosis. |
- Admit patients with a plasma glucose level of >250 mg/dL, a pH level of <7.3, a serum bicarbonate level of <18 meq/L, and ketones in their urine or blood.
- Search for the cause of all episodes of diabetic ketoacidosis.
- Consider consulting an endocrinologist for patients who are admitted with diabetic ketoacidosis to assist in management.
- See figure Guidelines for Therapy of Diabetic Ketoacidosis.
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Hospitalize patients with hypoglycemia and neuroglycopenia. |
- Admit patients with:
- Coma, seizures, or altered behavior caused by documented or suspected hypoglycemia
- Blood glucose level <50 mg/dL in whom outpatient treatment of hypoglycemia has not resulted in prompt recovery of sensorium
- Frequent swings between hypoglycemia (<50 mg/dL) and fasting hyperglycemia (>300 mg/dL)
- Treated hypoglycemia without a responsible adult who can be with the patient for 12 hours thereafter
- Adjust target glycemia based on the individual's risk for and recognition of hypoglycemia.
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Ensure perioperative glycemic control for surgical procedures.  |
- Hospitalize patients when necessary to avoid dehydration, electrolyte abnormalities, hypoglycemia, and hyperglycemia.
- Assess cardiovascular function, renal function, and diabetic complications before surgery.
- Optimize nutritional status and glucose control preoperatively if time permits.
- Treat patients with type 1 diabetes with intravenous insulin infusion perioperatively.
- See figure Insulin Infusion Regimen for Perioperative Diabetic Control.
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Consider inpatient admission to prevent and treat acute complications from contrast dye. |
- Avoid unnecessary contrast exposure.
- Hydrate patients carefully before, during, and after procedures that require contrast medium.
- Use intravenous fluids when necessary.
- Monitor urine output and renal function closely after the procedure is completed.
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Consider inpatient management for uncontrolled diabetes that cannot be regulated on an outpatient basis.  |
- Hospitalize for any of the following conditions:
- Hyperglycemia with volume depletion
- Persistent refractory hyperglycemia with metabolic deterioration
- Recurring fasting hyperglycemia (>300 mg/dL) that is refractory to outpatient therapy
- Glycated hemoglobin level that is twice the upper limit of normal and refractory to outpatient therapy
- Recurring episodes of severe hypoglycemia (<50 mg/dL) despite intervention
- Recurring diabetic ketoacidosis without precipitating infection or trauma
- Repeated absence from work due to severe psychosocial problems, leading to poor metabolic control
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| | | FAQs |
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| Abd Tahrani, MD, editorial consultant, has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations. Maureen D. Passaro, MD has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations. Robert E. Ratner, MD, is a consultant for Amylin Pharmaceuticals, AstraZeneca, GlaxoSmithKline, Lifescan, Inc., NovoNordisk, Sanofi-Aventis, Takeda, owns stocks in Merck, Johnson & Johnson, Abbott, received grants from Amylin, AstraZeneca, Bayhill Therapeutics, Boehringer Ingelheim, Conjuchem, Inc., Eil Lilly, GlaxoSmithKline, Merck, NovoNordisk, Pfizer, Sanofi-Aventis, Takeda.
Darren B. Taichman, MD, PhD, Editor, PIER, has received grant support from Actelion Pharmaceuticals Ltd , and honoraria for continuing medical education grand rounds and lectures given. |
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The information included herein should never be used as a substitute
for clinical judgment and does not represent an official position of
ACP. Because all PIER modules are updated regularly, printed web pages
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PIER is copyrighted (c) 2010 by the American College of Physicians,
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Diabetes Mellitus, Type 1
