Endocrine Diseases
Consider SUB-Q insulin to manage DKA
As a hospital pharmacist, you will hear renewed debate about the optimal insulin regimen for treating diabetic ketoacidosis (DKA) in adults . A recent retrospective study suggests that subcutaneous insulin, instead of IV, reduces ICU admissions, with no difference in hypoglycemia . This adds to other limited data suggesting subcutaneous insulin is safe and effecti…
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SNRIs
Compare medications for DIABETIC Neuropathy
Up to 50% of patients with diabetes develop peripheral neuropathy. Tailor medication selection based on side effects, cost, whether the medication can also treat other conditions, etc. Expect trial and error... Start at low doses and titrate to effect. But set realistic expectations. In general, fewer than 1 in 3 patients will see a 50% decrease in pain with first-l…
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Hyperglycemia
Manage HYPERglycemia in hospital
H yperglycemia was defined as a fasting or admission blood glucose > 126 mg/dL or a random blood glucose > 200 mg/dL. Serum blood glucose control should be done with basal and bolus insulin, with additional coverage with slide scale (correction insulin). Avoid sliding scale insulin alone as it associated with worse outcome. Glycemic control Ben…
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Type-2 Diabetes
Preventing and treating hypoglycemia in patients with type 2 diabetes
As a pharmacist, you'll see more emphasis on preventing and treating hypoglycemia in patients with type 2 diabetes, not just type 1. We all know that hypoglycemia can lead to confusion, seizures, and emergency room visits. But it can also impact driving, sleep, or work. Help your diabetes patients prevent and manage hypoglycemia... …
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Type-2 Diabetes
Prevention and treatment of diabetic foot infections
As a pharmacist, you'll see more focus on prevention and treatment of diabetic foot infections. More than half of foot ulcers in diabetes patients develop into diabetic foot infections... Recommend choosing empiric antibiotics based on infection severity and likely pathogens. For mild infections, recommend oral antibiotics that cover strep and S. aureus. Suggest …
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Surgery
Preop mgmt of diabetes meds in pts undergoing surgery
Overview ㅡ The goal is to help prevent the blood glucose seesaw. Consider these strategies, but be aware, evidence is lacking for the best preoperative glucose targets or protocols for diabetes medications. Continue to recommend avoiding tight blood glucose control around surgery to limit hypoglycemia. Generally aim to keep glucose below 180 mg/dL or lean toward less…
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Type-2 Diabetes
How to treat type 2 diabetes in heart failure patients?!
Some medications may cause or worsen heart failure . Recommend starting with metformin ( Glucophage ) in most heart failure patients. It improves outcomes and lactic acidosis fears are overblown. Then suggest adding medications that are NOT associated with heart failure such as an SGLT2 inhibitors or "flozin" group ( Jardiance , etc), GLP-1 agonist ( Byet…
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