Inpatient glycemic management

Last reviewed: 7 Jun 2022
Last updated: 12 Apr 2022

Summary

Definition

History and exam

Key diagnostic factors

  • history of diabetes mellitus
  • severe intercurrent illness or infection (hyperglycemia)
  • insulin use (hypoglycemia)
  • reduced level of consciousness/coma (hypoglycemia and hyperglycemia)
  • sweating (hypoglycemia)
  • tachycardia (hypoglycemia)
  • unusual behavior (hypoglycemia)
More key diagnostic factors

Other diagnostic factors

  • history of recent corticosteroid use
  • signs of diabetic retinopathy
  • signs of diabetic neuropathy
  • polyuria, polydipsia, or unintentional weight loss
Other diagnostic factors

Risk factors

  • severe illness (hyperglycemia or hypoglycemia)
  • corticosteroid use (hyperglycemia)
  • poorly controlled diabetes mellitus (hyperglycemia)
  • insulin administration or insulin secretagogues (hypoglycemia)
  • changes to corticosteroid or insulin regimen (hypoglycemia or hyperglycemia)
  • poor nutritional intake (hypoglycemia)
  • older age or cognitive impairment (hypoglycemia)
More risk factors

Diagnostic investigations

1st investigations to order

  • random plasma glucose
  • HbA1c
  • serum BUN, creatinine, and GFR calculation
  • spot urine albumin/creatinine ratio
  • serum ketones
More 1st investigations to order

Investigations to consider

  • post-discharge fasting plasma glucose or HbA1c
  • post-discharge oral glucose tolerance test
More investigations to consider

Treatment algorithm

ACUTE

critically ill or unplanned surgery or in ICU: hyperglycemia

stable noncritical illness: uncontrolled hyperglycemia

stable noncritical illness: well-controlled known diabetes

hypoglycemia

preoperative: minor elective surgery

Contributors

Authors

M. Cecilia Lansang, MD, MPH
M. Cecilia Lansang

Professor of Medicine

Director of Endocrinology, Main Campus

Department of Endocrinology, Diabetes and Metabolism

Cleveland Clinic

Cleveland

OH

Disclosures

MCL has received funding from Dexcom for research.

Keren Zhou, MD

Clinical Assistant Professor of Medicine

Research Director, Endocrinology and Metabolism Institute

Department of Endocrinology, Diabetes and Metabolism

Cleveland Clinic

Cleveland

OH

Disclosures

KZ declares that she has no competing interests

Acknowledgements

Dr M. Cecilia Lansang and Dr Keren Zhou would like to gratefully acknowledge Dr Suzanne Quinn, Dr Ajay Rao and Dr Vivian Fonseca, previous contributors to this topic.

Disclosures

SQ, AR and VF declare that they have no competing interests.

Peer reviewers

Guillermo E. Umpierrez, MD

Professor of Medicine

Division of Endocrinology

Metabolism and Lipids

Emory University School of Medicine

Atlanta

GA

Disclosures

GEU is an author of a number of references cited in this monograph.

Daniel Morganstein, MBBS, MA (Cantab), MRCP, PhD

Consultant Diabetologist

Beta Cell Unit

Chelsea and Westminster NHS Trust

London

UK

Disclosures

DM declares that he has no competing interests.

Sean Dinneen, MBBCh, FRCPI, FACP

Senior Lecturer in Medicine

National University of Ireland

Consultant in Diabetes and Endocrinology

Galway University Hospitals

Galway

Ireland

Disclosures

SD declares that he has no competing interests.

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