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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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
Manage diabetes medications during fasting
How should diabetes medications be managed while fasting? Fasting for morning labs usually doesn't require adjustments. But other fasts vary. For example, patients may fast from dawn to dusk during Ramadan or from sundown to sundown during Yom Kippur or 18 hours/day with some intermittent fasting diets. Help individualize a plan based on medications, and fast dur…
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Side Effects
Pay attention when quinolones used in diabetic patients
Stronger WARNINGS will lead to more concerns about quinolone risks . Quinolone labels already caution about hypo- and hyperglycemia, and certain CNS effects such as agitation, nervousness, or confusion. Now FDA will require warnings of hypoglycemic coma especially in the elderly, renal impairment, or in combination with …
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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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Type-2 Diabetes
Management of diabetes mellitus in primary care
SCREENING AND PREVENTION ㅡ Screen asymptomatic patients at increased risk for diabetes mellitus (family history of diabetes in twin, sibling, or parent, obesity, gestational diabetes and history of impaired glucose tolerance). Use fasting glucose determination; fasting test is preferred since it is most sensitive of methods appropriate for asymptomatic adult populati…
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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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