0 stringlengths 16 494 | embeddings listlengths 384 384 |
|---|---|
mal glucose lowering goal in critical illness.\nIn this trial, critically ill individuals random-ized to intensive glycemic management(80–110 mg/dL [4.4– 6.1 mmol/L]) derived\nno signi ficant treatment advantage\ncompared with a group with more mod-\nerate glycemic goals (140 –180 mg/dL | [
0.02825315296649933,
0.08395902067422867,
-0.05528458580374718,
-0.022243771702051163,
-0.032126814126968384,
-0.004510673228651285,
0.04164222255349159,
0.196751669049263,
-0.036262281239032745,
0.024716559797525406,
-0.048547253012657166,
0.06069469451904297,
-0.03116154484450817,
-0.016... |
erate glycemic goals (140 –180 mg/dL\n[7.8–10.0 mmol/L]) and had slightly butS296 Diabetes Care in the Hospital Diabetes Care Volume 47, Supplement 1, January 2024\n©AmericanDiabetesAssociation | [
0.023536914959549904,
0.0325450524687767,
-0.033061932772397995,
0.050936028361320496,
-0.07210933417081833,
-0.010831637308001518,
0.06004457548260689,
0.1180882528424263,
-0.08188188821077347,
-0.045667413622140884,
-0.05842537432909012,
0.008528503589332104,
-0.04068443551659584,
-0.075... |
significantly higher mortality (27.5% vs.\n25%). The intensively treated group had\n10- to 15-fold greater rates of hypogly-\ncemia, which may have contributed to\nthe adverse outcomes noted. The findings\nfrom the NICE-SUGAR trial, supported byseveral meta-analyses and a randomized\ncontrolled trial, showed higher rates... | [
0.05039806291460991,
0.02581511065363884,
-0.05259028822183609,
0.028112826868891716,
-0.024961192160844803,
-0.02805369719862938,
-0.023226691409945488,
0.13229863345623016,
-0.06805270165205002,
0.005667322780936956,
0.02462036907672882,
0.03593778610229492,
-0.02450050599873066,
-0.0202... |
controlled trial, showed higher rates of hy-\npoglycemia and an increase in mortality\nwith more aggressive glycemic manage-\nment goals compared with moderateglycemic goals (29– 3 1 ) .B a s e do nt h e s er e -\nsults, insulin and/or other therapies shouldbe initiated for the treatment of persis-\ntent hyperglycemia ... | [
0.0030949674546718597,
0.08232944458723068,
-0.055907923728227615,
-0.014266877435147762,
-0.021555250510573387,
0.02367381937801838,
0.03268994763493538,
0.11947283148765564,
-0.056516386568546295,
0.020703768357634544,
0.001676027080975473,
0.019777584820985794,
-0.00496641593053937,
-0.... |
tent hyperglycemia $180 mg/dL ( $10.0\nmmol/L). Once therapy is initiated, a gly-cemic goal of 140 –180 mg/dL (7.8 –10.0\nmmol/L) is recommended for most criticallyill individuals with hyperglycemia. Although\nnot as well supported by data from random-\nized controlled trials, these recommenda- | [
-0.0011310608824715018,
0.058075886219739914,
-0.020600344985723495,
0.02440468966960907,
-0.05296045169234276,
-0.012787028215825558,
0.06118888780474663,
0.11999814957380295,
-0.032439444214105606,
-0.0021077871788293123,
-0.01581289805471897,
-0.004615785554051399,
-0.0672617182135582,
... |
ized controlled trials, these recommenda-\ntions have been extended to hospitalizedindividuals without critical illness. More\nstringent glycemic goals, such as 110 –140\nmg/dL (6.1 –7.8 mmol/L), may be appropri-\nate for selected individuals (e.g., critically ill\nindividuals undergoing surgery) if it can be\nachieved... | [
0.018665660172700882,
0.03117993287742138,
-0.030105873942375183,
0.010838731192052364,
-0.037321094423532486,
-0.010659899562597275,
0.015405827201902866,
0.19455629587173462,
-0.0508076548576355,
-0.01874725893139839,
-0.01841949298977852,
0.021710390225052834,
-0.034012798219919205,
-0.... |
achieved without signi ficant hypoglycemia\n(32,33).\nFor inpatient management of hypergly-\ncemia in noncritical care settings, a glycemic\ngoal of 100– 180 mg/dL (5.6– 10.0 mmol/L)\nis recommended, whether it is new hyper-glycemia (e.g., newly diagnosed diabetesor stress hyperglycemia) or hyperglycemia\nrelated to dia... | [
0.024393677711486816,
0.062053076922893524,
-0.06644316762685776,
0.035543497651815414,
-0.11260905861854553,
-0.04298483952879906,
0.04871295765042305,
0.10165423899888992,
-0.05985790118575096,
-0.05452112853527069,
0.0058610206469893456,
0.015780366957187653,
-0.03451428562402725,
-0.03... |
related to diabetes prior to admission (2).\nIt has been found that fasting glucose\nlevels<100 mg/dL ( <5.6 mmol/L) are\npredictors of hypoglycemia within thenext 24 h (34). Glycemic levels up to 250\nmg/dL (13.9 mmol/L) may be acceptable\nin selected populations (terminally ill indi-\nviduals with short life expectan... | [
0.0867336317896843,
0.040194321423769,
-0.016677221283316612,
0.0180425476282835,
-0.026363128796219826,
-0.008229810744524002,
0.02779187634587288,
0.08702340722084045,
-0.07239530980587006,
-0.0048599462024867535,
-0.0016044598305597901,
0.025300823152065277,
-0.05430396646261215,
0.0099... |
viduals with short life expectancy, ad-\nvanced kidney failure [and/or on dialysis],\nhigh risk for hypoglycemia, and/or labileglycemic excursions). In these individu-\nals, less aggressive treatment goals that\nw o u l dh e l pa v o i ds y m p t o m a t i ch y p o g l y -\ncemia and/or hyperglycemia are often\nappropr... | [
-0.009488223120570183,
0.006851717829704285,
-0.012185492552816868,
0.0033163237385451794,
-0.062108609825372696,
0.008547581732273102,
0.009003693237900734,
0.16662222146987915,
-0.03328603506088257,
-0.02691042236983776,
0.006009588483721018,
0.017297280952334404,
-0.018285484984517097,
... |
appropriate. Clinical judgment combined\nwith ongoing assessment of clinical sta-\ntus, including changes in the trajectory of\nglucose measures, illness severity, nutri-\ntional status, or concomitant medicationsthat might affect glucose levels (e.g., gluco-\ncorticoids), may be incorporated into the\nday-to-day decis... | [
0.0073365578427910805,
0.040668707340955734,
-0.11645548790693283,
0.006392187438905239,
-0.07912477105855942,
0.014195923693478107,
-0.020550820976495743,
0.17915664613246918,
0.01608787477016449,
-0.023239057511091232,
0.0012976967263966799,
0.08434312045574188,
-0.11402815580368042,
0.0... |
day-to-day decisions regarding treatment\ndosing.GLUCOSE MONITORING\nIn hospitalized individuals with diabetes\nwho are eating, point-of-care (POC) bloodglucose monitoring should be performedbefore meals; in those not eating, glucose\nmonitoring is advised every 4 –6h( 2 6 ) .\nMore frequent POC blood glucose moni- | [
-0.044247817248106,
0.07445403188467026,
-0.04237334802746773,
0.01123740803450346,
-0.08378364890813828,
-0.04795173555612564,
0.08690054714679718,
0.030001331120729446,
-0.014425606466829777,
-0.04118144139647484,
-0.02371324971318245,
0.045929983258247375,
-0.16731908917427063,
0.004916... |
More frequent POC blood glucose moni-\ntoring ranging from every 30 min to every2 h is the required standard for safe useof intravenous insulin therapy.\nHospital blood glucose monitoring should\nb ep e r f o r m e dw i t hU . S .F o o da n dD r u gA d -ministration (FDA) –approved POC hospital- | [
-0.04833541437983513,
0.03622144088149071,
-0.10598738491535187,
-0.029054267331957817,
-0.02801116555929184,
-0.09490921348333359,
0.04723357409238815,
0.06808102875947952,
0.022601095959544182,
-0.033554647117853165,
-0.04519148916006088,
0.045935727655887604,
-0.11009606719017029,
0.015... |
calibrated glucose monitoring systems (35).POC blood glucose meters are not as accu-rate or as precise as laboratory glucose ana-\nlyzers, and capillary blood glucose readings | [
-0.04230256751179695,
-0.006194971036165953,
-0.11582385748624802,
-0.05167171731591225,
-0.03740086033940315,
-0.08276143670082092,
0.03064454346895218,
0.03980175405740738,
0.04636884480714798,
0.008630326017737389,
0.0053433761931955814,
-0.05966336652636528,
-0.06480301916599274,
0.037... |
lyzers, and capillary blood glucose readings\na r es u b j e c tt oa r t i f a c t sd u et op e r f u s i o n ,edema, anemia/erythrocytosis, and severalmedications commonly used in the hospital(35) ( Table 7.1 ). The FDA has established\nstandards for capillary (fi nger-stick) POC glu- | [
-0.07295912504196167,
-0.048466842621564865,
-0.08278391510248184,
-0.008147669956088066,
0.023763936012983322,
-0.05099102482199669,
0.06017638370394707,
0.10493830591440201,
0.0079461969435215,
-0.04833005368709564,
0.041697632521390915,
0.050137702375650406,
-0.10304710268974304,
0.0530... |
standards for capillary (fi nger-stick) POC glu-\ncose monitoring in the hospital (35). The bal-ance between analytic requirements (e.g.,accuracy, precision, and interference) andclinical requirements (e.g., rapidity, simplic-ity, and POC) has not been uniformly re-\nsolved (35 –38), and most hospitals have\narrived at ... | [
-0.05130764842033386,
-0.027857189998030663,
-0.04622782766819,
-0.0523352175951004,
-0.03449697047472,
-0.08925089240074158,
0.018581975251436234,
0.09639003127813339,
0.009559142403304577,
-0.05412472411990166,
0.02865954115986824,
0.011399398557841778,
-0.029440611600875854,
0.073482707... |
arrived at their own policies to balance\nthese parameters. It is critically importantthat devices selected for in-hospital use, andthe workfl ow through which they are ap- | [
-0.05701129510998726,
0.07933329790830612,
-0.044320739805698395,
-0.06536886841058731,
-0.06501258909702301,
-0.0065436395816504955,
0.05359065905213356,
0.09277395904064178,
-0.036149442195892334,
0.01789838634431362,
0.08232199400663376,
0.05034443363547325,
0.045765675604343414,
-0.017... |
plied, undergo careful analysis of perfor-mance and reliability and ongoing qualityassessments (38). Recent studies indicatethat POC measures provide adequate infor-mation for usual practice, with only rare in-stances where care has been compromised(36,37). Best practice dictates that any glu-\ncose result that does no... | [
-0.006869109347462654,
-0.05447695031762123,
-0.032012879848480225,
-0.016680721193552017,
-0.0848497673869133,
-0.07035642862319946,
0.058075521141290665,
0.048872046172618866,
0.011007742956280708,
-0.03304647281765938,
0.06592157483100891,
0.03808646276593208,
-0.02446683496236801,
0.05... |
cose result that does not correlate with the\nindividual ’s clinical status should be con-\nfirmed by measuring a sample in the clinical\nlaboratory, particularly for asymptomatic hy-poglycemic events.\nContinuous Glucose Monitoring\nRecommendations\n16.6 In people with diabetes using a\npersonal continuous glucose moni... | [
-0.016820089891552925,
0.06292878836393356,
-0.07688688486814499,
-0.007082084193825722,
-0.06793995946645737,
-0.022512678056955338,
0.05619676783680916,
0.09803323447704315,
-0.009374348446726799,
-0.037665605545043945,
-0.028584441170096397,
-0.022229425609111786,
-0.08660366386175156,
... |
personal continuous glucose monitor-\ning (CGM) device, the use of CGMshould be continued during hospitali-\nzation if clinically appropriate, with\nconfirmatory point-of-care (POC) glu- | [
-0.09890294075012207,
0.05016373470425606,
-0.0767674595117569,
-0.01673424243927002,
-0.0510256327688694,
0.005121317692101002,
0.0711933895945549,
0.11660990864038467,
0.006441090255975723,
-0.04456038028001785,
-0.0011411679442971945,
0.0007137990323826671,
-0.08241690695285797,
0.04607... |
confirmatory point-of-care (POC) glu-\ncose measurements for insulin dosingdecisions and hypoglycemia assess-ment, if resources and training areavailable, and according to an institu-tional protocol. B16.7 For people with diabetes using an\nautomated insulin delivery (AID) system | [
-0.06198246777057648,
-0.017206232994794846,
-0.08827102929353714,
0.01935107819736004,
-0.03498346731066704,
-0.01621263474225998,
0.14429126679897308,
0.035018693655729294,
0.0065563395619392395,
-0.0708891972899437,
0.015288103371858597,
0.06710992753505707,
-0.06312771141529083,
0.0000... |
automated insulin delivery (AID) system\nalong with CGM, the use of AID andCGM should be continued during hospi-talization if clinically appropriate, withconfirmatory POC blood glucose meas-\nurements for insulin dosing decisionsand hypoglycemia assessment, if resour-\nces and training are available, and ac-\ncording to... | [
-0.10310909897089005,
0.060061100870370865,
-0.0666634663939476,
0.013814587146043777,
-0.015704095363616943,
-0.013159270398318768,
0.08368320763111115,
0.09853707253932953,
-0.12459734827280045,
0.021816691383719444,
0.0005996758700348437,
0.020674658939242363,
-0.07412724941968918,
0.05... |
cording to an institutional protocol. C\nSeveral studies have demonstrated that\ninpatient use of continuous glucose moni-\ntoring (CGM) has advantages over POC\nglucose monitoring in detecting hypogly-\ncemia, particularly nocturnal, prolonged\nand/or asymptomatic hypoglycemia (39 –41),\nand in reducing recurrent hypo... | [
-0.05704038217663765,
0.08462703227996826,
-0.09788044542074203,
0.02680804952979088,
-0.012378270737826824,
0.014443233609199524,
0.027889491990208626,
0.08968895673751831,
0.021324612200260162,
-0.009605197235941887,
-0.043710626661777496,
0.0036464056465774775,
-0.09882334619760513,
0.0... |
and in reducing recurrent hypoglycemia\n(42,43). However, at this time, initiating\nuse of a new CGM device has not been\napproved by the FDA. During the corona-\nvirus disease 2019 (COVID-19) pandemic,many institutions used CGM in ICU and\nnon-ICU settings, with the aim of mini-\nmizing exposure time and saving person... | [
-0.020162532106041908,
0.06196780502796173,
-0.030613159760832787,
0.022472474724054337,
0.008303720504045486,
0.016755517572164536,
0.03199415281414986,
0.14130616188049316,
-0.047349926084280014,
-0.004756223410367966,
-0.013271147385239601,
0.014781411737203598,
0.018597709015011787,
0.... |
mizing exposure time and saving personal\nprotective equipment, under an FDA pol-\nicy of enforcement discretion (44,45). Dataon the safety and effi cacy of real-time\nCGM use in the hospital, particularly with\nimplementation of remote monitoring\n(e.g., a glucose telemetry system), is\ngrowing (42,43,45– 50).\nContinu... | [
-0.0439763069152832,
0.06720367074012756,
-0.03267618641257286,
-0.030522573739290237,
-0.00796846766024828,
0.0011873054318130016,
0.10921458899974823,
0.16898587346076965,
-0.04674998298287392,
0.0488160103559494,
0.06535749137401581,
0.047394830733537674,
-0.0008623574394732714,
0.04587... |
growing (42,43,45– 50).\nContinuation of personal CGM device\nuse, particularly for people with type 1 or\ntype 2 diabetes treated with intensive ther-\napy at increased risk for hypoglycemia\nduring hospitalization, is recommended.\nConfirmatory POC capillary glucose test-\ning, using hospital-calibrated glucose me- | [
-0.019082162529230118,
0.06006189063191414,
-0.04946466535329819,
-0.0038619907572865486,
-0.02870536595582962,
-0.04028324782848358,
0.04415159672498703,
0.14364978671073914,
-0.11192440241575241,
0.005413330625742674,
0.023589156568050385,
-0.060983121395111084,
-0.09651679545640945,
0.0... |
ing, using hospital-calibrated glucose me-\nters, is recommended for insulin dosing\nand hypoglycemia assessment (e.g., hy-\nbrid testing protocols) (51). People with\ndiabetes should be counseled aboutmeaningful use of trend arrows and\nalarms and about notifying nursing staff\nfor con firmation of these events with | [
0.009289981797337532,
0.0290391743183136,
-0.0828084796667099,
0.03621615469455719,
-0.024641038849949837,
0.010316485539078712,
0.09763985127210617,
0.051309630274772644,
-0.042589858174324036,
-0.032701633870601654,
-0.03783551603555679,
0.02557276375591755,
-0.0728113055229187,
0.077939... |
for con firmation of these events with\nPOC capillary glucose testing. Similarly,\ncontinuation of AID systems should besupported during hospitalization, when\nclinically appropriate, and with proper\nstaff training and supervision (41,45). Ob-\nservational studies have demonstrated | [
-0.018406499177217484,
0.04874768108129501,
-0.06532053649425507,
0.007086653262376785,
0.030506564304232597,
-0.010252670384943485,
-0.014140293933451176,
0.07557011395692825,
-0.030914753675460815,
-0.005053929053246975,
0.012662936002016068,
0.030114833265542984,
-0.08765348047018051,
0... |
servational studies have demonstrated\nimprovements in patient satisfaction andimproved detection of glycemic excursions\n(40,47). If the reason for admission is sus-\npected to be related to device malfunction\nor lack of adequate education/training or | [
0.07222245633602142,
0.03040885552763939,
-0.00047507890849374235,
-0.004566359333693981,
-0.07100508362054825,
-0.04593281447887421,
0.0645090788602829,
0.11714524030685425,
-0.038905419409275055,
-0.0312193613499403,
-0.009913084097206593,
0.03151552379131317,
-0.04076913744211197,
0.011... |
or lack of adequate education/training or\nuse, consultation with the endocrinology/diabetesjournals.org/care Diabetes Care in the Hospital S297\n©AmericanDiabetesAssociation | [
0.07571501284837723,
0.03169817477464676,
-0.04555729031562805,
0.10745296627283096,
-0.023078711703419685,
-0.003134709084406495,
-0.013372358866035938,
-0.0035555853974074125,
-0.04705362766981125,
-0.03883522376418114,
-0.0319744348526001,
-0.007211983669549227,
-0.07688219100236893,
0.... |
diabetes care team or diabetes care and\neducation specialists, if available, is rec-ommended. Hospitals are encouraged todevelop institutional policies and have\ntrained personnel with knowledge of dia-\nbetes technology. Recent review articlesprovide details on accuracy, interfer-\nences, precautions, and contraindic... | [
-0.015005755238234997,
0.06846117973327637,
-0.007187049835920334,
0.007466176524758339,
-0.10297159105539322,
-0.03597584366798401,
0.06288404762744904,
0.050952885299921036,
-0.01676296256482601,
-0.03674318268895149,
-0.04129073768854141,
0.041710224002599716,
-0.05276790261268616,
0.03... |
ences, precautions, and contraindications\nof diabetes technology devices in thehospital setting (50,51).\nFor more information on CGM, see\nSection 7, “Diabetes Technology. ”\nGLUCOSE-LOWERING TREATMENT\nIN HOSPITALIZED PATIENTS\nAn individualized approach for glycemic\nmanagement is encouraged throughout\nthe hospita... | [
0.0024663391523063183,
0.08931905031204224,
0.0038897499907761812,
-0.0023783145006746054,
-0.0938870906829834,
0.02768241986632347,
0.04747861623764038,
0.14187641441822052,
-0.08315121382474899,
-0.025088267400860786,
-0.018623042851686478,
0.02844494767487049,
-0.03792175278067589,
-0.0... |
the hospital stay and should take into\nconsideration several predictive factorsfor achieving glycemic goals, such as\nprior home use and dose of insulin or\nnoninsulin therapy, expected level of in-sulin resistance, prior A1C, current glu-\ncose levels, oral intake, and duration of\ndiabetes.\nInsulin Therapy\nRecomme... | [
0.029923846945166588,
0.0068642995320260525,
-0.07982668280601501,
0.019115040078759193,
-0.0788101851940155,
0.02096378803253174,
0.00845214445143938,
0.08472152054309845,
-0.12097898870706558,
-0.05879891663789749,
-0.0317181795835495,
0.040149983018636703,
-0.07079162448644638,
-0.03211... |
diabetes.\nInsulin Therapy\nRecommendations\n16.8 Basal insulin or a basal plus bolus\ncorrection insulin plan is the preferred\ntreatment for noncritically ill hospital-\nized individuals with poor oral intake\nor those who are taking nothing bymouth. A\n16.9 An insulin plan with basal, pran-\ndial, and correction com... | [
0.012779505923390388,
0.05065223574638367,
-0.06182246655225754,
-0.00204028794541955,
-0.11459614336490631,
0.0031070460099726915,
0.06758002936840057,
0.12633489072322845,
-0.01766924001276493,
0.006947544869035482,
0.018513858318328857,
0.057983532547950745,
-0.10112444311380386,
0.0133... |
dial, and correction components is the\npreferred treatment for most noncriti-\ncally ill hospitalized individuals withadequate nutritional intake. A\n16.10 Sole use of a correction or\nsupplemental insulin without basalinsulin (formerly referred to as a\nsliding scale) in the inpatient setting\nis discouraged. A\nCrit... | [
0.0007263731677085161,
0.01907276175916195,
-0.040844183415174484,
-0.025521256029605865,
-0.15627537667751312,
-0.013503188267350197,
0.04502382129430771,
0.10754716396331787,
-0.003329112194478512,
-0.06364945322275162,
0.03227522596716881,
0.058729641139507294,
-0.05623398721218109,
-0.... |
is discouraged. A\nCritical Care Setting\nContinuous intravenous insulin infusion\nis the most effective method for achiev-ing speci fic glycemic goals and avoiding\nhypoglycemia in the critical care setting.\nIntravenous insulin infusions should be\nadministered using validated written orcomputerized protocols that all... | [
-0.03750435635447502,
0.04089667648077011,
-0.12366525828838348,
0.030160337686538696,
-0.05453525111079216,
-0.022723473608493805,
0.02607414312660694,
0.08066623657941818,
-0.07760133594274521,
-0.014657876454293728,
-0.015944812446832657,
0.03972351923584938,
-0.03265192359685898,
0.003... |
prede fined adjustments in the insulin in-\nfusion rate based on glycemic fluctua-\ntions and immediate past and current\ninsulin infusion rates (52). For diabetic\nketoacidosis (DKA) and hyperglycemichyperosmolar state (HHS) management, | [
-0.008411329239606857,
0.04528368264436722,
-0.1120246946811676,
0.02611484006047249,
-0.06947505474090576,
0.010283037088811398,
0.008553938008844852,
0.08953724801540375,
-0.03600218892097473,
-0.00597826624289155,
-0.014038299210369587,
0.022304801270365715,
-0.05905141681432724,
-0.030... |
continuous intravenous insulin infusion isgiven for correction of hyperglycemia, hyper-ketonemia, and acid-base disorder followingafixed-rate intravenous insulin infusion (53)\nor nurse-driven protocol with a variable ratebased on glucose values (54). Individualswith mild and uncomplicated DKA can bemanaged with subcuta... | [
-0.021217258647084236,
0.038413289934396744,
-0.058360956609249115,
0.05448969453573227,
-0.08990022540092468,
-0.013875075615942478,
0.023119309917092323,
0.0668073371052742,
-0.03361348807811737,
-0.009662124328315258,
-0.03939782455563545,
0.039681244641542435,
-0.03308001905679703,
0.0... |
sulin doses given every 1 –2 h (55).\nNoncritical Care Setting\nIn most instances, insulin is the preferred\ntreatment for hyperglycemia in hospital-ized individuals. In certain circumstances,\nit may be appropriate to continue home | [
-0.005283075850456953,
0.01166362315416336,
-0.05823419243097305,
0.03655305877327919,
-0.06354764103889465,
-0.013722531497478485,
0.050668325275182724,
0.0811275914311409,
-0.051667094230651855,
-0.07510743290185928,
-0.026392662897706032,
0.09107520431280136,
-0.07766532897949219,
0.048... |
it may be appropriate to continue home\noral glucose-lowering medications, suchas dipeptidyl peptidase 4 inhibitors (DPP-4i)(52,56). If oral medications are held in the\nhospital but will be reinstated after dis-\ncharge, there should be a protocol forguiding resumption of home medications1–2 days prior to discharge. F... | [
-0.010331985540688038,
-0.019618302583694458,
-0.0034477654844522476,
-0.048185378313064575,
-0.019601868465542793,
-0.018638556823134422,
-0.023297462612390518,
0.0585540346801281,
-0.02045932598412037,
-0.043719660490751266,
-0.029624521732330322,
0.10878923535346985,
-0.057358235120773315... |
taking insulin, several reports indicate thatinpatient use of insulin pens is safe andmay improve nurse satisfaction whensafety protocols, including nursing edu-\ncation, are in place to guarantee single-\nperson use (57 –61).\nOutside of critical care units, scheduled\nsubcutaneous insulin orders are recom-mended for ... | [
-0.07122993469238281,
0.021996065974235535,
-0.07175455242395401,
0.017451319843530655,
-0.0516224168241024,
0.04096640646457672,
0.12992262840270996,
0.024606354534626007,
-0.0617145337164402,
0.0013090033316984773,
0.009828343987464905,
0.12671521306037903,
-0.05105416849255562,
0.034583... |
glycemia in people with diabetes and\nhyperglycemia. Use of insulin analogs orhuman insulin results in similar glycemicoutcomes in the hospital setting but may\nincrease severe hypoglycemic events (62).\nThe use of subcutaneous rapid- or short-acting insulin before meals, or every 4 –6h\nif no meals are given or if the... | [
-0.010078292340040207,
0.06335452944040298,
-0.044914811849594116,
0.02718459628522396,
-0.0724673792719841,
-0.016762427985668182,
0.08172700554132462,
0.06434676796197891,
-0.0452079139649868,
-0.015278331935405731,
0.025249185040593147,
0.07980811595916748,
-0.03091699257493019,
-0.0353... |
if no meals are given or if the individual is\nreceiving continuous enteral/parenteral\nnutrition, is indicated to correct or pre-vent hyperglycemia. Basal insulin, or abasal plus bolus correction schedule, isthe preferred treatment for noncritically\nill hospitalized individuals with inadequate | [
0.012379785999655724,
0.041579391807317734,
-0.04906601831316948,
0.03930016979575157,
-0.10628077387809753,
-0.009691688232123852,
0.05051198601722717,
0.04717452824115753,
0.001422466360963881,
-0.04037053510546684,
0.07152172178030014,
0.020773418247699738,
-0.04146687313914299,
-0.0187... |
ill hospitalized individuals with inadequate\nor restricted oral intake. An insulin sched-ule with basal, prandial, and correctioncomponents is the preferred treatment\nfor most noncritically ill hospitalized people\nwith diabetes with adequate nutritionalintake.\nA randomized controlled trial has shown | [
0.035275571048259735,
0.02443142607808113,
-0.08384621888399124,
0.044261522591114044,
-0.10553700476884842,
0.03630436211824417,
0.048991210758686066,
0.13444331288337708,
-0.008380662649869919,
-0.008940191008150578,
-0.013568383641541004,
0.04221086949110031,
-0.05569235235452652,
-0.01... |
A randomized controlled trial has shown\nthat basal plus bolus treatment improvedglycemic outcomes and reduced hospitalcomplications compared with a correctionor supplemental insulin without basal insu-lin (formerly known as sliding scale) for\npeople with type 2 diabetes admitted for | [
-0.02673855423927307,
-0.0065042502246797085,
-0.046949174255132675,
0.043740224093198776,
-0.015690961852669716,
0.005498247686773539,
-0.007386847399175167,
0.09247510135173798,
-0.017331423237919807,
-0.008976170793175697,
0.06009471416473389,
0.059702493250370026,
-0.05756080150604248,
... |
people with type 2 diabetes admitted for\ngeneral surgery (63). Prolonged use ofcorrection or supplemental insulin withoutbasal insulin as the sole treatment of hy-perglycemia is strongly discouraged in the\ninpatient setting, with the exception of\npeople with type 2 diabetes in noncritical\ncare with mild hyperglycem... | [
0.016575247049331665,
0.05222722142934799,
-0.03533761575818062,
0.039020176976919174,
-0.06718060374259949,
-0.03139019012451172,
0.02648056298494339,
0.04008568823337555,
-0.10228379815816879,
-0.03934985771775246,
-0.0006981895421631634,
0.09852579236030579,
-0.06705620139837265,
-0.023... |
care with mild hyperglycemia (2,64,65).\nA prospective randomized inpatient\nstudy of 70/30 intermediate-acting (NPH)/regular insulin mixture versus basal-bolus\ntherapy showed comparable glycemic out-comes but signi ficantly increased hypogly-\ncemia in the group receiving insulin mixture(66). Therefore, insulin mixtur... | [
0.060171473771333694,
0.031845107674598694,
-0.06811518222093582,
0.0324336476624012,
-0.03864410147070885,
-0.054487887769937515,
0.05916616693139076,
0.04661865904927254,
-0.08389486372470856,
-0.0035677258856594563,
-0.03400333225727081,
0.000759085058234632,
-0.06364249438047409,
-0.02... |
25, 70/30, or 50/50 insulins are not rou-\ntinely recommended for in-hospital use.\nData on the use of glargine U-300\nand degludec U-100 or U-200 in the in-patient and perioperative settings arelimited. A few studies have shown that\nthey demonstrated similar ef ficacy and\nsafety compared with glargine U-100(67–69). A... | [
-0.00501983892172575,
0.00034998924820683897,
-0.11010108888149261,
-0.040729817003011703,
-0.02533922716975212,
-0.07276156544685364,
0.09717122465372086,
0.11647123098373413,
-0.09207960963249207,
0.0010358827421441674,
-0.021251101046800613,
0.020957356318831444,
-0.06098717451095581,
0... |
able evidence for weekly insulin use inhospital or surgical settings.\nType 1 Diabetes\nF o rp e o p l ew i t ht y p e1d i a b e t e s ,d o s i n g\ninsulin based solely on premeal glucose\nlevels does not account for basal insulin\nrequirements or caloric intake, increasingthe risk of both hypoglycemia and hyper- | [
0.005127526354044676,
0.051612965762615204,
-0.05599866807460785,
0.048958972096443176,
0.004831654019653797,
0.008989408612251282,
0.06689292937517166,
0.04235583171248436,
-0.08641206473112106,
0.009947740472853184,
-0.043362006545066833,
0.05094657093286514,
-0.05225716531276703,
0.0172... |
glycemia. Typically, basal insulin dosing is\nbased on body weight and expected sen-\nsitivity to insulin, with some evidence\nthat people with renal insuf ficiency\nshould be treated with lower insulindoses (70,71). An insulin schedule withbasal and correction components is nec-\nessary for all hospitalized individuals... | [
0.00566653860732913,
0.02372036501765251,
-0.051248811185359955,
0.0196466576308012,
-0.0961541086435318,
-0.061471860855817795,
0.1290704607963562,
0.07969434559345245,
-0.05971480533480644,
0.012214748188853264,
-0.009116045199334621,
0.024453986436128616,
-0.031320370733737946,
0.004229... |
essary for all hospitalized individuals with\ntype 1 diabetes, even when taking noth-\ning by mouth, with the addition of pran-\ndial insulin when eating. Policies and best\npractice alerts in the EHR should be put in\nplace to ensure that basal insulin (givensubcutaneously, via insulin pump or by in-\nsulin infusion) ... | [
0.011685478501021862,
0.058857742697000504,
-0.07926549762487411,
-0.03795626387000084,
-0.017794417217373848,
-0.028559094294905663,
0.1303475797176361,
0.09891672432422638,
-0.012279625050723553,
-0.021347612142562866,
0.044970642775297165,
0.020192893221974373,
-0.03636336699128151,
0.0... |
sulin infusion) is not held for people with\ntype 1 diabetes, especially during care\ntransitions, and that ongoing prescriber\nand nursing education is provided (60).\nTransitioning From Intravenous to\nSubcutaneous Insulin\nWhen discontinuing intravenous insulin, a\ntransition protocol is recommended, as it\nis assoc... | [
-0.06622546911239624,
-0.01986442506313324,
-0.0985054150223732,
0.037882111966609955,
-0.07354454696178436,
0.0070833079516887665,
0.03587948530912399,
0.07446235418319702,
-0.035491716116666794,
-0.0727967917919159,
0.008424937725067139,
0.10100147873163223,
-0.057072099298238754,
0.0861... |
is associated with less morbidity and\nlower costs of care. Subcutaneous basal\ninsulin should be given 2 h before intrave-\nnous infusion is discontinued, with theaim of minimizing rebound hyperglycemia\n(2,72,73).S298 Diabetes Care in the Hospital Diabetes Care Volume 47, Supplement 1, January 2024\n©AmericanDiabetes... | [
-0.015862954780459404,
-0.00881804246455431,
-0.08131588250398636,
0.037732262164354324,
-0.03835038095712662,
0.007450289558619261,
-0.007337663788348436,
0.16261519491672516,
-0.043018076568841934,
-0.051418736577034,
0.03153526410460472,
0.04620450362563133,
-0.05082663893699646,
0.0074... |
Emerging data from several studies\nshow that the administration of a low dose\n(0.15–0.3 units/kg) of basal insulin analog\nin addition to intravenous insulin infusionmay reduce the duration of insulin infusionand length of hospital stay and prevent re-bound hyperglycemia without increasedrisk of hypoglycemia (74 –76)... | [
0.021136917173862457,
0.06431183218955994,
-0.07323931902647018,
0.03742583468556404,
-0.05733778700232506,
-0.025518063455820084,
0.0743376687169075,
0.12295938283205032,
-0.01438471581786871,
0.0029062621761113405,
0.009127956815063953,
0.03425189107656479,
0.008645554073154926,
0.006067... |
For transitioning, the total daily dose of\nsubcutaneous insulin can be calculatedbased on the insulin infusion rate duringthe prior 6 –8 h when stable glycemic goals\nwere achieved, based on prior home insulin\ndose, or following a weight-based approach(72,73). For people being transitioned toconcentrated insulin (U-2... | [
-0.006842064205557108,
0.020184341818094254,
-0.08988635241985321,
0.018442664295434952,
-0.01154615543782711,
-0.03196558356285095,
0.06216651201248169,
0.1026238203048706,
-0.07570303231477737,
-0.037854623049497604,
-0.013417569920420647,
-0.011835102923214436,
-0.00666247121989727,
-0.... |
U-500) in the inpatient setting, it is impor-\ntant to ensure correct dosing by using a sep-arate pen or vial for each person and bymeticulous pharmacy and nursing supervi-sion of the dose administered (77,78).\nNoninsulin Therapies\nRecommendation\n16.11 For people with type 2 diabetes\nhospitalized with heart failure... | [
-0.005018229596316814,
0.04839642718434334,
-0.06296911835670471,
-0.014564006589353085,
-0.07056137919425964,
-0.037805818021297455,
0.06280715018510818,
0.10267429053783417,
-0.0371493361890316,
-0.08789374679327011,
-0.06264260411262512,
0.0730895921587944,
-0.04319358244538307,
0.05248... |
hospitalized with heart failure, it is\nrecommended that use of a sodium –\nglucose cotransporter 2 inhibitor be\ninitiated or continued during hospital-\nization and upon discharge, if thereare no contraindications and after re-covery from the acute illness. A\nThe safety and ef ficacy of noninsulin\nglucose-lowering t... | [
-0.008086333982646465,
0.014825179241597652,
-0.018116764724254608,
-0.020697185769677162,
-0.007804957218468189,
0.018171941861510277,
-0.04316852614283562,
0.11541441828012466,
-0.0002655021380633116,
-0.08925104886293411,
0.0372781977057457,
0.0384833961725235,
0.050053905695676804,
0.0... |
glucose-lowering therapies in the hospital\nsetting has expanded recently (79 –83). A\nrandomized trial and an observational study\nhave demonstrated the safety and ef ficacy\nof DPP-4i in speci fic groups of hospitalized\npeople with diabetes (84,85). The use of | [
-0.00232589989900589,
0.08585677295923233,
-0.03199220448732376,
-0.0025169719010591507,
-0.03675537183880806,
0.027817418798804283,
0.021828044205904007,
0.15716005861759186,
0.020393332466483116,
0.02799520082771778,
-0.0629652887582779,
0.09304767102003098,
-0.04815753176808357,
-0.0055... |
people with diabetes (84,85). The use of\nDPP-4i with or without basal insulin may bea safer and simpler plan for people withmild to moderate hyperglycemia on admis-sion (e.g., admission glucose <180–200\nmg/dL), with reduced risk of hypoglycemia\n(79,85,86). Of note, the FDA states that | [
0.012207415886223316,
0.06950044631958008,
-0.0685807466506958,
0.016658561304211617,
-0.02168421261012554,
0.018801560625433922,
0.11782079190015793,
0.1208563968539238,
-0.06495418399572372,
-0.0021382365375757217,
0.022146552801132202,
0.055838823318481445,
-0.1019119843840599,
-0.00949... |
(79,85,86). Of note, the FDA states that\nhealth care professionals should considerdiscontinuing saxagliptin and alogliptin inpeople who develop heart failure (87). Dataon the inpatient use of glucagon-like pep-tide 1 (GLP-1) receptor agonists are stillmostly limited to research studies and selectpopulations that are m... | [
-0.03763224929571152,
-0.030144628137350082,
-0.06406214833259583,
0.002190814120694995,
-0.11012181639671326,
0.03369419649243355,
-0.04397871717810631,
0.12533120810985565,
-0.04750346019864082,
-0.0860908254981041,
0.020160699263215065,
0.04925699532032013,
-0.015496228821575642,
-0.017... |
For people with type 2 diabetes hospital-\nized with heart failure, it is recommendedthat use of a sodium –glucose cotransporter\n2 (SGLT2) inhibitor be initiated or continued\nduring hospitalization and upon discharge,if there are no contraindications and after\nrecovery from the acute illness (88,89). | [
-0.02544369176030159,
0.032134898006916046,
-0.04023164138197899,
-0.005304176826030016,
-0.019519725814461708,
0.02017621509730816,
-0.008765274658799171,
0.10261040925979614,
-0.001999159110710025,
-0.06703715026378632,
0.021337591111660004,
0.0710853636264801,
-0.03299844264984131,
0.07... |
recovery from the acute illness (88,89).\nSGLT2 inhibitors should be avoided in casesof severe illness, in people with ketonemiaor ketonuria, and during prolonged fastingand surgical procedures (90– 93). Proac- | [
-0.05366545543074608,
-0.00365862506441772,
0.01970968395471573,
-0.06397727131843567,
-0.015002710744738579,
0.022085677832365036,
-0.020565340295433998,
0.1874104142189026,
-0.04226865991950035,
-0.012901111505925655,
0.04602528363466263,
0.05696249008178711,
-0.07795552164316177,
0.0604... |
tive adjustment of diuretic dosing is rec-ommended during hospitalization and/ordischarge, especially in collaboration witha cardiology/heart failure consult team(90–93). The FDA has warned that SGLT2\ninhibitors should be stopped 3 days before\nscheduled surgeries (4 days in the case of\nertugli flozin) (94).\nHYPOGLYC... | [
-0.028735533356666565,
0.022895554080605507,
0.011261679232120514,
0.019062869250774384,
-0.01488908939063549,
-0.061817094683647156,
-0.033693499863147736,
0.1144161969423294,
-0.002270478755235672,
-0.0741128996014595,
0.023108849301934242,
0.025777297094464302,
0.041753578931093216,
0.0... |
ertugli flozin) (94).\nHYPOGLYCEMIA\nRecommendations\n16.12 A hypoglycemia management\nprotocol should be adopted and imple-\nmented by each hospital or hospital\nsystem. A plan for preventing and treat-\ning hypoglycemia should be established\nfor each individual. Episodes of hypo-\nglycemia in the hospital should be\n... | [
0.030735960230231285,
0.11641569435596466,
-0.044746775180101395,
0.011484216898679733,
-0.06816945970058441,
-0.006936619523912668,
0.06131850928068161,
0.13100314140319824,
-0.0674368217587471,
-0.05414564535021782,
0.004160762764513493,
0.0002310631243744865,
-0.05641649663448334,
0.005... |
documented in the electronic health\nrecord and tracked for quality assess-\nment and quality improvement. E\n16.13 Treatment plans should be re-\nviewed and changed as necessary to\nprevent hypoglycemia and recurrent\nhypoglycemia when a blood glucose\nvalue of <70 mg/dL ( <3.9 mmol/L) is\ndocumented. C\nPeople with o... | [
-0.026947442442178726,
0.0730181485414505,
-0.030920308083295822,
0.008800907991826534,
-0.04125140607357025,
-0.029048427939414978,
0.03587637096643448,
0.10219593346118927,
-0.04898989573121071,
-0.005292796064168215,
-0.009071343578398228,
0.0553901307284832,
-0.08932920545339584,
0.000... |
documented. C\nPeople with or without diabetes may ex-\nperience hypoglycemia in the hospital\nsetting. While hypoglycemia is associatedwith increased mortality (95,96), in manycases, it is a marker of an underlying dis-\nease rather than the cause of fatality. | [
0.030114000663161278,
0.07855471968650818,
-0.0747084766626358,
0.06389117240905762,
0.02215682715177536,
0.03522752597928047,
0.0791834369301796,
0.10291259735822678,
-0.05148350074887276,
-0.0011703060008585453,
-0.004981031641364098,
0.011333191767334938,
-0.003795777913182974,
-0.00902... |
However, hypoglycemia is a severe conse-quence of dysregulated metabolism and/ordiabetes treatment, and it is imperativethat it be minimized during hospitalization.Many episodes of inpatient hypoglycemiaare preventable. A hypoglycemia preven-tion and management protocol should beadopted and implemented by each hos-pita... | [
0.010739686898887157,
0.11888130754232407,
-0.034405287355184555,
0.0397927388548851,
-0.04509761184453964,
-0.000549919146578759,
0.07400509715080261,
0.08665508031845093,
-0.025253498926758766,
-0.028479864820837975,
-0.024886827915906906,
0.04709196463227272,
0.00758825708180666,
0.0286... |
beadopted and implemented by each hos-pital or hospital system. A standardizedhospital-wide, nurse-initiated hypoglycemia | [
0.05849546566605568,
0.044934410601854324,
-0.05378812924027443,
0.0674472451210022,
-0.05891278386116028,
-0.01113001350313425,
-0.006793177220970392,
0.04935392737388611,
-0.008789223618805408,
-0.031345270574092865,
-0.0865960419178009,
0.01952420175075531,
-0.028273645788431168,
0.0269... |
treatment protocol should be in place to\nimmediately address blood glucose levels<70 mg/dL ( <3.9 mmol/L) (97,98). In addi- | [
-0.02106821909546852,
0.07814809679985046,
-0.08462453633546829,
0.016697684302926064,
-0.07996141910552979,
-0.02867620252072811,
-0.0008567746262997389,
0.12779711186885834,
-0.09377159178256989,
-0.017865236848592758,
-0.015559395775198936,
0.00019828841323032975,
-0.0996050015091896,
0... |
tion, individualized plans for preventingand treating hypoglycemia for each individ-ual should also be developed. An AmericanDiabetes Association consensus statementrecommends that an individual ’st r e a t m e n tplan be reviewed any time a blood glucose\nvalue of <70 mg/dL ( <3.9 mmol/L) occurs,\nas this level often ... | [
-0.024478252977132797,
0.07080484926700592,
-0.059842173010110855,
0.05884433910250664,
-0.07520651817321777,
0.004343684297055006,
0.038704246282577515,
0.035635266453027725,
-0.025057101622223854,
0.018248818814754486,
-0.053038060665130615,
0.032722923904657364,
-0.09244556725025177,
0.... |
as this level often predicts subsequent level\n3 hypoglycemia (99). Episodes of hypoglyce-\nmia in the hospital should be documented\nin the EHR and tracked (1). A key strategy is\nembedding hypoglycemia treatment into allinsulin and insulin infusion orders.\nInpatient Hypoglycemia: Risk\nFactors, Treatment, and Preven... | [
0.031157374382019043,
0.025920908898115158,
-0.06603250652551651,
0.03236323595046997,
0.00017955208022613078,
-0.01602766290307045,
0.023783253505825996,
0.06661829352378845,
-0.10237263888120651,
-0.03945450484752655,
-0.04281005635857582,
-0.0341670885682106,
-0.003633836517110467,
0.01... |
Inpatient Hypoglycemia: Risk\nFactors, Treatment, and Prevention\nInsulin is one of the most common medi-\ncations causing adverse events in hospital-\nized individuals. Errors in insulin dosing,missed doses, and/or administration errors\nincluding incorrect insulin type and incor-\nrect timing of dose occur relatively... | [
0.04117543622851372,
0.05499797314405441,
-0.06330884993076324,
0.04902543127536774,
-0.02349078096449375,
-0.01922527886927128,
0.08482114225625992,
0.1124700978398323,
-0.05810405686497688,
-0.06509727984666824,
-0.024822799488902092,
0.059722900390625,
0.001657642307691276,
0.0172758884... |
rect timing of dose occur relatively fre-\nquently (100 –102) and include prescriber\n(ordering), pharmacy (dispensing), and\nnursing (administration) errors. Common\npreventable sources of iatrogenic hypogly-\ncemia are improper prescribing of other\nglucose-lowering medications and inap- | [
0.03300733491778374,
-0.018487410619854927,
-0.007208197843283415,
-0.005785014480352402,
-0.062089260667562485,
-0.06996501237154007,
0.06850921362638474,
0.157898411154747,
0.02239893190562725,
-0.02251104824244976,
0.006353288888931274,
0.010402035899460316,
0.05525044724345207,
0.04211... |
glucose-lowering medications and inap-\npropriate management and follow-up ofthefirst episode of hypoglycemia (103). Kid-\nney failure is an important risk factor for hy-poglycemia in the hospital (104), possibly\nas a result of decreased insulin clearance.\nStudies of “bundled” preventive therapies,\nincluding proactiv... | [
-0.06625737994909286,
0.08354897052049637,
-0.022321792319417,
0.04521109536290169,
0.004504965152591467,
-0.007791600655764341,
0.0858122855424881,
0.10058770328760147,
-0.06454014033079147,
-0.010538168251514435,
0.03717772290110588,
0.0824551209807396,
-0.044449131935834885,
0.012136812... |
including proactive surveillance of glycemic\noutliers and an interdisciplinary data-driven\napproach to glycemic management, showed\nthat hypoglycemic episodes in the hospi-\ntal could be reduced or prevented. Com-pared with baseline, studies found that\nhypoglycemic events decreased by\n56–80% (98,105,106). The Joint... | [
0.06092449277639389,
0.12069890648126602,
-0.013262658379971981,
0.0468083880841732,
0.008143248967826366,
-0.020283890888094902,
0.04923098906874657,
0.06709139049053192,
-0.05567163974046707,
-0.0246034637093544,
0.030330106616020203,
0.05481066182255745,
-0.04119039326906204,
-0.0461254... |
56–80% (98,105,106). The Joint Commis-\nsion, a global quality improvement andpatient safety in health care organiza-tion, recommends that all hypoglycemic\nepisodes be evaluated for a root cause\nand the episodes be aggregated and re-\nviewed to address systemic issues (23).\nIn addition to errors with insulin treatme... | [
0.04118354991078377,
0.0429811030626297,
-0.05447778478264809,
0.062031954526901245,
-0.02647380344569683,
-0.022883452475070953,
0.0271149892359972,
0.09872730076313019,
-0.06154845282435417,
-0.02888408862054348,
0.0009950508829206228,
0.0751589983701706,
0.003562756348401308,
-0.0203318... |
In addition to errors with insulin treatment,\niatrogenic hypoglycemia may be induced by asudden reduction of corticosteroid dose,\nreduced oral intake, emesis, inappropriatetiming of short- or rapid-acting insulin\ndoses in relation to meals, reduced infusion\nrate of intravenous dextrose, unexpected\ninterruption of ... | [
0.014055382460355759,
0.04569521173834801,
-0.03679763898253441,
0.0476471446454525,
-0.025302337482571602,
-0.016586296260356903,
0.0244571715593338,
0.08662679046392441,
-0.0822865292429924,
-0.019739529117941856,
0.004905840381979942,
0.03572217375040054,
0.004559409338980913,
-0.016533... |
interruption of enteral or parenteral feedings,\ndelayed or missed blood glucose checks, andaltered ability of the individual to report\nsymptoms (107).\nRecent inpatient studies show promise\nfor CGM as an early warning system toalert of impending hypoglycemia, offering | [
-0.039208948612213135,
0.026203608140349388,
-0.020072191953659058,
0.04149167612195015,
-0.0390595942735672,
0.04543587565422058,
0.02909296564757824,
0.1203661859035492,
-0.0522998571395874,
-0.026662396267056465,
-0.01383432187139988,
-0.01627245731651783,
-0.0511140450835228,
0.0705552... |
an opportunity to mitigate it before it hap-pens (46 –49). The use of personal CGM\nand AID devices, such as insulin pumpsdiabetesjournals.org/care Diabetes Care in the Hospital S299\n©AmericanDiabetesAssociation | [
-0.07471556961536407,
0.08814211189746857,
-0.026419490575790405,
0.035004351288080215,
-0.017981840297579765,
0.08582679182291031,
0.09117688983678818,
0.059581153094768524,
-0.07480785250663757,
-0.005491024814546108,
-0.037080783396959305,
0.09289071708917618,
-0.10127084702253342,
0.01... |
that can automatically deliver correction\ndoses and change basal delivery rates in | [
-0.0012886256445199251,
0.008180195465683937,
-0.03533370420336723,
0.03522632271051407,
-0.04930844530463219,
-0.03013378195464611,
-0.020473117008805275,
0.0882817879319191,
0.023574216291308403,
0.02272273786365986,
0.12249911576509476,
0.0360734649002552,
-0.015761731192469597,
0.03836... |
real time, should be supported for ongo-ing use during hospitalization for individu-als who are capable of using their devicessafely and independently when properoversight supervision is available. Hospi-tals should be encouraged to develop poli-cies and protocols to support inpatientuse of individual- and hospital-own... | [
-0.10639562457799911,
0.019453544169664383,
-0.036161694675683975,
-0.09618384391069412,
-0.04965578019618988,
-0.06033388152718544,
0.04663717374205589,
0.04623962193727493,
-0.012567246332764626,
0.0027613407000899315,
0.06628415733575821,
0.05414680019021034,
-0.03693322837352753,
0.015... |
of individual- and hospital-owned dia-betes technology and have expert staffavailable for safe implementation andevaluation of continued use during the | [
-0.04413431137800217,
0.0632733702659607,
-0.0007417789893224835,
-0.08666158467531204,
-0.10135817527770996,
-0.04062844067811966,
0.06761141866445541,
0.06259258091449738,
-0.020089514553546906,
0.02239602617919445,
-0.015881652012467384,
0.0942811518907547,
0.0365290530025959,
0.0353173... |
hospital stay (51). Hospital information\ntechnology teams are beginning to inte-grate CGM data into the EHR. The abilityto download and interpret diabetes de-vice data during hospitalization can informinsulin dosing during hospitalization andcare transitions (41).\nFor more information on CGM, see\nSection 7, “Diabete... | [
-0.032704908400774,
0.05495228245854378,
-0.07833601534366608,
-0.027826419100165367,
-0.028963327407836914,
0.04493431746959686,
0.05232894420623779,
0.09607891738414764,
-0.02732549048960209,
-0.02226743847131729,
-0.043855004012584686,
0.03553595766425133,
-0.024674950167536736,
0.00626... |
For more information on CGM, see\nSection 7, “Diabetes Technology. ”\nPredictors of Hypoglycemia | [
-0.030304234474897385,
0.034575168043375015,
-0.06628695875406265,
0.051113586872816086,
-0.0587381012737751,
0.02247757837176323,
0.06970961391925812,
0.14652036130428314,
-0.08793320506811142,
-0.011103066615760326,
-0.059174999594688416,
0.019225487485527992,
-0.05430062487721443,
0.032... |
Predictors of Hypoglycemia\nIn people with diabetes, it is well establishedthat an episode of severe hypoglycemia in-creases the risk for a subsequent event,partly because of impaired counterregula-tion (108,109). In a study of hospitalizedindividuals, 84% of people who had an epi-sode of severe hypoglycemia (de fined a... | [
-0.007092171348631382,
0.03544648364186287,
-0.05805739015340805,
0.08969295024871826,
0.006718590389937162,
0.04730740934610367,
0.08839228749275208,
0.10400452464818954,
-0.042645931243896484,
0.01269510667771101,
-0.031201815232634544,
0.02273714356124401,
-0.008530688472092152,
0.01756... |
<40 mg/dL [ <2.2 mmol/L]) had a preced-\ning episode of hypoglycemia (< 70 mg/dL\n[<3.9 mmol/L]) during the same admis-\nsion (110). In another study of hypoglyce-\nmic episodes (de fined as <50 mg/dL\n[<2.8 mmol/L]), 78% of individuals were\ntaking basal insulin, with the incidence of\nhypoglycemia peaking between midn... | [
0.06302151083946228,
0.03232384845614433,
-0.039798103272914886,
0.06282386183738708,
-0.027000796049833298,
-0.03203039988875389,
0.0857502818107605,
0.0918378233909607,
-0.07248581200838089,
0.030402634292840958,
0.002061242936179042,
-0.015987444669008255,
-0.014987588860094547,
0.01299... |
hypoglycemia peaking between midnightand 6:00\nA.M. Despite recognition of hypo-\nglycemia, 75% of individuals did not havetheir dose of basal insulin changed beforethe next basal insulin administration (111).\nRecently, several groups have devel-\noped algorithms to predict episodes of\nhypoglycemia in the inpatient s... | [
0.023990178480744362,
0.007403994910418987,
-0.055989768356084824,
0.023573681712150574,
-0.006682172417640686,
-0.03950924053788185,
0.0427534244954586,
0.09912348538637161,
-0.06374318897724152,
-0.026892870664596558,
-0.038489967584609985,
-0.00048061329289339483,
-0.01292626652866602,
... |
hypoglycemia in the inpatient setting\n(112,113). Models such as these are po-\ntentially important and, once validatedfor general use, could provide a valu-able tool to reduce rates of hypoglyce-mia in the hospital. In one retrospectivecohort study, a fasting blood glucose of<100 mg/dL was shown to be a predic-\ntor o... | [
0.0392426997423172,
0.06800872832536697,
-0.0414700023829937,
0.03419303148984909,
-0.07069268822669983,
0.0004431302077136934,
0.01586870290338993,
0.04266216978430748,
0.000030879680707585067,
-0.04834486544132233,
-0.003269148524850607,
0.026066232472658157,
0.002130820881575346,
0.0305... |
tor of next-day hypoglycemia (34).\nMEDICAL NUTRITION THERAPY IN\nTHE HOSPITAL\nThe goals of medical nutrition therapy\nin the hospital are to provide adequatecalories to meet metabolic demands, opti-\nmize glycemic outcomes, address personal | [
-0.023487120866775513,
0.11471259593963623,
-0.047418270260095596,
0.024212177842855453,
-0.05810021609067917,
-0.007532890886068344,
0.04658830538392067,
0.04492693766951561,
-0.07451548427343369,
-0.06078754737973213,
-0.012689677998423576,
-0.0021626302041113377,
0.0016855541616678238,
... |
mize glycemic outcomes, address personal\nfood preferences, and facilitate the crea-tion of a discharge plan. The American Di-abetes Association does not endorse anysingle meal plan or speci fied percentages\nof macronutrients. Current nutrition rec- | [
-0.02920459397137165,
0.04437055438756943,
0.024581288918852806,
0.07303766161203384,
-0.02054513432085514,
0.012185582891106606,
0.0976821556687355,
0.07263273745775223,
-0.05080816149711609,
-0.029688511043787003,
-0.0003403174923732877,
0.03722330927848816,
-0.08381092548370361,
-0.0184... |
of macronutrients. Current nutrition rec-\nommendations advise individualizationb a s e do nt r e a t m e n tg o a l s ,p h y s i o l o g i c a lparameters, and medication use. Con-trolled carbohydrate meal plans, wherethe amount of carbohydrate on each\nmeal tray is calculated, are preferred by | [
-0.045085299760103226,
-0.017825424671173096,
-0.03340118005871773,
-0.012084465473890305,
-0.0445665642619133,
0.0952124074101448,
0.055854421108961105,
0.07017161697149277,
-0.044034674763679504,
-0.0410182923078537,
0.009016945958137512,
-0.05881732702255249,
-0.05816091597080231,
-0.08... |
meal tray is calculated, are preferred by\nmany hospitals, as they facilitate match-ing the prandial insulin dose to theamount of carbohydrate given (114). Or-ders should also indicate that the mealdelivery and nutritional insulin coverage\nshould be coordinated, as their variability | [
-0.01749243028461933,
0.09046576172113419,
-0.06216363236308098,
-0.017689494416117668,
-0.07256120443344116,
-0.009079142473638058,
0.04284346103668213,
0.08657296746969223,
-0.005228592082858086,
-0.039263542741537094,
0.020174890756607056,
-0.053393006324768066,
-0.013846717774868011,
-... |
should be coordinated, as their variability\noften creates the possibility of hypergly-cemic and hypoglycemic events (20).Some hospitals offer “meals on demand, ”\nwhere individuals may order meals from\nthe menu at any time during the day. This\noption improves patient satisfaction but\ncomplicates insulin –meal coord... | [
-0.006215184461325407,
0.042554352432489395,
-0.03912559524178505,
0.03367741405963898,
-0.08306869119405746,
0.020048780366778374,
0.04483051225543022,
-0.04253531992435455,
0.05209611728787422,
-0.05266052484512329,
0.07937120646238327,
0.084725521504879,
-0.030695270746946335,
-0.019641... |
complicates insulin –meal coordination\nand can lead to insulin stacking if meals\nare too close together. Finally, if the hos-pital food service supports carbohydrate\ncounting, this option should be made\navailable to people with diabetes count-ing carbohydrates at home and peoplewearing insulin pumps (115,116).\nSEL... | [
-0.046130258589982986,
0.004615163896232843,
-0.07611292600631714,
0.027167804539203644,
-0.07551897317171097,
-0.01322950329631567,
0.08425603806972504,
0.009625316597521305,
-0.05406878516077995,
-0.07407892495393753,
-0.0019385439809411764,
0.06319712102413177,
-0.0760488212108612,
-0.0... |
SELF-MANAGEMENT IN THE\nHOSPITAL\nDiabetes self-management in the hospital\nmay be appropriate for speci fic individuals\nwho wish to continue to perform self-care\nwhile acutely ill (117 –119). Candidates in- | [
0.01725929044187069,
0.03281585872173309,
-0.027611885219812393,
0.017429344356060028,
-0.08725888282060623,
0.007784369867295027,
0.10255761444568634,
0.04672675579786301,
-0.020980605855584145,
0.006306866183876991,
-0.02733772061765194,
0.003242228180170059,
-0.10369779169559479,
0.0186... |
while acutely ill (117 –119). Candidates in-\nclude children with parental supervision,adolescents, and adults who successfullyperform diabetes self-management athome and whose cognitive and physical\nskills needed to successfully self-administer | [
-0.01766645349562168,
0.02203318476676941,
-0.05077889934182167,
0.03404221683740616,
-0.06914564967155457,
0.03726905956864357,
0.10107746720314026,
0.08401630818843842,
-0.014372102916240692,
0.01464240811765194,
0.03491700440645218,
0.03638596832752228,
-0.09520667791366577,
0.067758090... |
skills needed to successfully self-administer\ninsulin and perform glucose monitoring arenot compromised (7,41). In addition, theyshould have adequate oral intake, be profi -\ncient in carbohydrate estimation, take mul-\ntiple daily insulin injections or wear insulin\npumps, have stable insulin requirements, | [
0.00952092744410038,
0.031244108453392982,
-0.08273874968290329,
0.04204193502664566,
-0.10452164709568024,
-0.05632703751325607,
0.07286099344491959,
0.03408731892704964,
-0.11566800624132156,
-0.03257909044623375,
-0.08014979213476181,
-0.02382119558751583,
-0.10900461673736572,
0.040677... |
pumps, have stable insulin requirements,\nand understand sick-day management. Ifself-management is supported, a policyshould include a requirement that peoplewith diabetes and the care team agree\nthat self-management is appropriate on a | [
-0.03869129717350006,
0.05248168483376503,
-0.04466638341546059,
0.00307666789740324,
-0.040601979941129684,
0.00574961444362998,
0.08776505291461945,
0.02516024373471737,
-0.11306383460760117,
-0.014211676083505154,
0.010776200331747532,
0.0464671328663826,
-0.04139914736151695,
0.0308121... |
daily basis during hospitalization. Hospitalpersonal medication policies may includeguidance for people with diabetes whowish to take their own or hospital-dispensedinsulin and noninsulin injectable medica-tions during their hospital stay. A hospitalpolicy for personal medication may considera pharmacy exception on a c... | [
-0.05377630516886711,
0.06710734218358994,
-0.030218428000807762,
-0.032829418778419495,
-0.06680013239383698,
0.02414735034108162,
0.138314351439476,
0.05109179764986038,
0.011867154389619827,
-0.06150666996836662,
0.003071666695177555,
0.0753849670290947,
-0.009718481451272964,
0.0559577... |
sis along with the care team. Pharmacy\nmust verify any home medication and re-quire a prescriber order for the individualto self-administer home or hospital-\ndispensed medication under the su-\npervision of the registered nurse. If aninsulin pump or CGM device is worn,hospital policy and procedures delin-eating guide... | [
-0.0670066550374031,
0.017220696434378624,
-0.07164182513952255,
0.008149225264787674,
-0.06681564450263977,
-0.019781898707151413,
0.054223790764808655,
0.0225483700633049,
-0.044122155755758286,
-0.04210466146469116,
0.0302482508122921,
0.0332895964384079,
-0.01598779484629631,
0.0107549... |
pump and/or CGM device should be de-\nveloped according to consensus guide-lines, including the changing of insulininfusion sites and CGM glucose sensors(41,120,121). As outlined in Recommenda-\ntions 7.33 and 7.34, people with diabetes | [
-0.0763583555817604,
0.02145918272435665,
-0.030264610424637794,
-0.023221993818879128,
-0.028821643441915512,
-0.036845333874225616,
0.06307713687419891,
0.07146691530942917,
-0.06519856303930283,
-0.04769499972462654,
-0.005795551463961601,
0.052379757165908813,
-0.07522592693567276,
0.0... |
Subsets and Splits
No community queries yet
The top public SQL queries from the community will appear here once available.