Nancy Moline – Improving Diabetes Management: Tools for the Nurse

Outline

Glycemic Targets for Hospitalized Patients

• Clear interpretation of AACE & ADA guidelines
• Adjusting limits for the critically ill patient
• Non-critical patients: How high is too high

Recognizing Symptoms of Hypoglycemia

• Hypoglycemic unawareness: How are we missing this?
• Interventions that change outcomes
• 15/15 Rule
• Timing and Dose: The good, the bad, the ugly
  • IV dextrose
  • Glucagon

Reducing Incidence of Hypoglycemia

• Finger sticks & technique – it does matter!
• Critical timing for pre-meal & correction insulin
• The nurse’s role in ensuring carbohydrate-consistent meals

Symptoms & Critical Interventions for Hyperglycemia

• The differences of DKA & HHNK
• Diabetic Ketoacidosis
  • A complex metabolic process
  • Identifying the patient at risk
  • Managing fluid replacement to avoid complications
  • Insulin drips
  • Critical labs & acute management
• Nursing Management of HHNK
  • Identifying the symptoms
  • Don’t forget your ABCs
  • Common laboratory pitfalls
  • Restoring electrolyte balance

Consequences of Acute Hyperglycemia

• Addressing & managing new wound infections
• The dangers of:
  • Platelet abnormalities
  • Inflammatory cytokine response
• The patient & the facility at risk:
  • Poor patient outcomes
  • Readmissions
  • Increased length of stay
• Insulin resistance

Treating Special Populations Using a Simple Formula

• The patient newly prescribed steroids
• Adjusting for tube feedings
• TPN: Understanding the effects for the diabetic patient
• Considerations for patients on R-U-500 insulin

Insulin for Improved Glucose Control

• Type 1 vs. Type 2 guidelines
• Action times of insulins
• Calculating Basal/ Bolus Insulin
• Miami 4/12 Rule
• Correction scales based on insulin sensitivity

Oral Agents in the Hospital Setting

• NPO vs eating status
• Precautions for Metformin

Safety Issues with Managing Insulin Pumps

• Patient exclusion criteria
• Recognizing pump problems
• When to remove pumps

System Improvements Positively Impacting Patient Outcomes

• Standardized correction scales based on insulin sensitivity
• Standard protocols for treating hypoglycemia
• Physician order sets for insulin initiation
• Carbohydrate labels on meal trays/snacks

Putting It All Together

• Case Studies: What went right and what went wrong
• Solving problems using the glucose accordion flowsheet report