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insulin sliding scale

Merete B Christensen, Anders Gotfredsen, Kirsten Nørgaard
BACKGROUND: Hyperglycemia during hospitalization is associated with increased rates of complications and longer hospital stays. Various insulin regimens are used in the inpatient diabetes management of non-critically ill patients. We aimed to assess the efficacy and safety of basal-bolus insulin therapy (BBI) by summarizing evidence from studies of BBI versus sliding scale insulin therapy (SSI) in the management of hospitalized non-critically ill type 2 diabetes patients. METHODS: We searched MEDLINE, EMBASE, Scopus and the Cochrane Library for studies comparing BBI therapy with SSI therapy in hospitalized non-critically ill patients with type 2 diabetes...
January 9, 2017: Diabetes/metabolism Research and Reviews
Saki Harada, Akio Suzuki, Shohei Nishida, Ryo Kobayashi, Sayuri Tamai, Keisuke Kumada, Nobuo Murakami, Yoshinori Itoh
Insulin is frequently used for glycemic control. Medication errors related to insulin are a common problem for medical institutions. Here, we prepared a standardized sliding scale insulin (SSI) order sheet and assessed the effect of its introduction. Observations before and after the introduction of the standardized SSI template were conducted at Gifu University Hospital. The incidence of medication errors, hyperglycemia, and hypoglycemia related to SSI were obtained from the electronic medical records. The introduction of the standardized SSI order sheet significantly reduced the incidence of medication errors related to SSI compared with that prior to its introduction (12/165 [7...
December 7, 2016: Journal of Evaluation in Clinical Practice
Jordan Masse, Christopher Alan Giuliano, Sara Brown, Renee Alexander Paxton
PURPOSE: The purpose of this study was to examine the association between long-acting insulin and hypoglycemia in nondiabetic surgical intensive care patients. METHODS: This single-center, retrospective cohort study evaluated glycemic control in nondiabetic critically ill surgical patients receiving long-acting insulin plus sliding scale versus those receiving sliding scale alone. Patients were matched based on sliding scale order and type of surgery. The primary outcome was the proportion of patients who experienced hypoglycemia (glucose values <70 mg/dL)...
November 7, 2016: Journal of Intensive Care Medicine
Jeniece Trast Ilkowitz, Steven Choi, Michael L Rinke, Kathy Vandervoot, Rubina A Heptulla
BACKGROUND: Diabetes ketoacidosis (DKA) is a life-threatening complication of type 1 diabetes mellitus (T1DM). Reducing DKA admissions in children with T1DM requires a coordinated, comprehensive management plan. We aimed to decrease DKA admissions, 30-day readmissions, and length of stay (LOS) for DKA admissions. METHODS: A multipronged intervention was designed in 2011 to reach all patients: (1) increase insulin pump use and basal-bolus regimen versus sliding scales, (2) transform educational program, (3) increased access to medical providers, and (4) support for patients and families...
October 2016: Quality Management in Health Care
J A Van Heerden, J R Burger, J J Gerber
BACKGROUND: Prescribing for older patients is a well-recognised problem, and inappropriate items are prescribed frequently. Several tools and criteria are available to promote rational prescribing in older patients. OBJECTIVE: To determine the prevalence of potentially inappropriate prescriptions (PIPs) in older South African patients. METHODS: A retrospective drug utilisation review was conducted using medicine claims data over a 1-year period...
September 9, 2016: South African Medical Journal, Suid-Afrikaanse Tydskrif Vir Geneeskunde
Naoji Mita, Shinji Kawahito, Tomohiro Soga, Kazumi Takaishi, Hiroshi Kitahata, Munehide Matsuhisa, Mitsuo Shimada, Hiroyuki Kinoshita, Yasuo M Tsutsumi, Katsuya Tanaka
The aim of the present study was to evaluate the usefulness of a closed-loop system (STG-55; Nikkiso, Tokyo, Japan), a type of artificial endocrine pancreas for the continuous monitoring and control of intraoperative blood glucose, for preventing postoperative acute kidney injury (AKI) in patients undergoing hepatectomy. Thirty-eight patients were enrolled in this study. Glucose concentrations were controlled with either a manual injection of insulin based on a commonly used sliding scale (manual insulin group, n = 19) or the programmed infusion of insulin determined by the control algorithm of the artificial endocrine pancreas (programmed insulin group, n = 19)...
August 24, 2016: Journal of Artificial Organs: the Official Journal of the Japanese Society for Artificial Organs
V Borzì, S Frasson, G Gussoni, M Di Lillo, R Gerloni, G Augello, G Gulli, A Ceriello, B Solerte, E Bonizzoni, A Fontanella
AIMS: Hypoglycemia is a potential risk in the management of patients suffering from type 2 diabetes (T2DM) and hospitalized in internal medicine units (IMUs). The aim of this analysis was to evaluate incidence of hypoglycemia and related risk factors in a group of patients admitted to IMUs. METHODS: We used the FADOI-DIAMOND study carried out in 53 Italian IMUs. The DIAMOND design included two cross-sectional surveys interspersed with an educational program. In both phases each center reviewed the charts of the last 30 hospitalized patients with known T2DM (n=3167), including information about hypoglycemia during hospital stay...
May 2016: Diabetes Research and Clinical Practice
Carmen Caballero Requejo, Elena Urbieta Sanz, Abel Trujillano Ruiz, Celia García-Molina Sáez, María Onteniente Candela, Pascual Piñera Salmerón
OBJECTIVES: To analyze if the hypoglycemic therapy prescribed in the Emergency Department adapts to the consensus recommendations available, as well as to assess its clinical impact. METHODS: A descriptive observational study, which included patients awaiting hospital admission, who were in the Observation Ward of the Emergency Department and had been previously diagnosed with diabetes mellitus, and were receiving treatment with hypoglycemic drugs at home. The management of antidiabetic treatment and its clinical impact were assessed...
1, 2016: Farmacia Hospitalaria
Robin L Koffarnus, Lisa M Mican, Debra A Lopez, Jamie C Barner
OBJECTIVE: This study evaluated adherence to American Diabetes Association (ADA) recommendations for diabetes monitoring following an educational intervention for physicians in an inpatient psychiatric hospital. METHODS: This retrospective chart review was conducted in an inpatient psychiatric institution from July 1, 2010-January 15, 2011. A total of 120 subjects (60 subjects each in the pre- and post-intervention groups) meeting the inclusion criteria served as the study sample...
March 1, 2016: American Journal of Health-system Pharmacy: AJHP
Hannah Lise Sutheran, Timothy Reynolds
AIMS: Manufacturers of point-of-care testing (POCT) glucose systems must adhere to International Organisation for Standardisation (ISO) 15197 performance standards, a tightened version of which becomes mandatory in May 2016. Using methods deviating from the evaluation requirements of ISO 15197, we investigated the accuracy and clinical utility of three glucose testing systems. METHODS: Whole blood glucose was measured on 62 EDTA-preserved samples with each system followed by plasma glucose determination with a laboratory hexokinase method...
October 2016: Journal of Clinical Pathology
Karam Choi, Tae Jung Oh, Jung Chan Lee, Myungjoon Kim, Hee Chan Kim, Young Min Cho, Sungwan Kim
Although various basal-bolus insulin therapy (BBIT) protocols have been used in the clinical environment, safer and more effective BBIT protocols are required for glucose control in hospitalized patients with type 2 diabetes (T2D). Modeling approaches could provide an evaluation environment for developing the optimal BBIT protocol prior to clinical trials at low cost and without risk of danger. In this study, an in-silico model was proposed to evaluate subcutaneous BBIT protocols in hospitalized patients with T2D...
February 2016: Journal of Korean Medical Science
Covadonga Gómez Cuervo, Ana Sánchez Morla, María Asunción Pérez-Jacoiste Asín, Otilia Bisbal Pardo, Luis Pérez Ordoño, Juan Vila Santos
INTRODUCTION: The aim of this review was to assess the effectiveness to reduce clinical adverse events and safety of insulin administered in basal-bolus-corrector or basal-corrector regimens (BB) versus a sliding scale scheme (SS) in patients with diabetes or newly diagnosed hyperglycemia admitted to a conventional (not critical) medical or surgical hospital ward. METHOD: A Medline search was conducted. The Odds ratio was the main summary measure. A random effects model with the Mantel-Haenszel procedure was used...
April 2016: Endocrinología y Nutrición: órgano de la Sociedad Española de Endocrinología y Nutrición
Richard J Strilka, Mamie C Stull, Michael S Clemens, Stewart C McCaver, Scott B Armen
BACKGROUND: The critically ill can have persistent dysglycemia during the "subacute" recovery phase of their illness because of altered gene expression; it is also not uncommon for these patients to receive continuous enteral nutrition during this time. The optimal short-acting subcutaneous insulin therapy that should be used in this clinical scenario, however, is unknown. Our aim was to conduct a qualitative numerical study of the glucose-insulin dynamics within this patient population to answer the above question...
January 27, 2016: Theoretical Biology & Medical Modelling
Medha N Munshi, Hermes Florez, Elbert S Huang, Rita R Kalyani, Maria Mupanomunda, Naushira Pandya, Carrie S Swift, Tracey H Taveira, Linda B Haas
Diabetes is more common in older adults, has a high prevalence in long-term care (LTC) facilities, and is associated with significant disease burden and higher cost. The heterogeneity of this population with regard to comorbidities and overall health status is critical to establishing personalized goals and treatments for diabetes. The risk of hypoglycemia is the most important factor in determining glycemic goals due to the catastrophic consequences in this population. Simplified treatment regimens are preferred, and the sole use of sliding scale insulin (SSI) should be avoided...
February 2016: Diabetes Care
Thiruvinvamalai S Dharmarajan, Dheeraj Mahajan, Annie Zambrano, Bikash Agarwal, Rachel Fischer, Zahra Sheikh, Anna Skokowska-Lebelt, Meenakshi Patel, Rebecca Wester, Naga P Madireddy, Naushira Pandya, Florence T Baralatei, Jackie Vance, Edward P Norkus
INTRODUCTION: Sliding scale insulin (SSI) therapy remains a common means of insulin therapy in long-term care (LTC) for the management of type 2 diabetes mellitus, despite current recommendations not supportive of the form of therapy today. Lack of randomized trial data on the efficacy and safety of basal-bolus insulin (B-BI) therapy in nursing home residents may have precluded this form of insulin administration in the LTC setting. Our study is a comparison of the efficacy of SSI (control) and B-BI (intervention) therapies during a 21-day intervention trial in older nursing home residents...
March 1, 2016: Journal of the American Medical Directors Association
Emily K Acton, Charles E Leonard, Mark H Schutta, Serena Cardillo, Andrea B Troxel, Rebecca Trotta, Sean Hennessy
BACKGROUND: To examine the feasibility of implementing clinician-supported inpatient self-managed insulin to aid in the planning of a randomized clinical trial. RESULTS: We conducted a proof-of-concept interventional study of inpatients with diabetes mellitus who had hospital orders for basal-bolus or sliding scale insulin. Patients meeting inclusion criteria were offered the opportunity to manage their own basal-bolus insulin with support from a diabetes nurse practitioner...
October 1, 2015: BMC Research Notes
J Sonya Haw, Farnoosh Farrokhi, Dawn Smiley, Limin Peng, David Reyes, Christopher Newton, Francisco J Pasquel, Priyathama Vellanki, Guillermo E Umpierrez
OBJECTIVE: To evaluate the impact of different subcutaneous basal insulin regimens on glycemic variability (GV) and hospital complications in non-intensive care unit (ICU) patients with type 2 diabetes (T2D). METHODS: This study is a post hoc analysis of 279 general medicine and surgery patients treated with either a "Basal Bolus" insulin regimen using glargine once daily and glulisine before meals or a "Basal Plus" regimen using glargine once daily plus correction doses of glulisine before meals for glucose >140 mg/dL...
December 2015: Endocrine Practice
A Barg, H Hörterer, M Jacxsens, M Wiewiorski, J Paul, V Valderrabano
OBJECTIVE: To correct the underlying inframalleolar varus deformity and to restore physiologic biomechanics of the hindfoot. INDICATIONS: Neurologic, posttraumatic, congenital, and idiopathic cavovarus deformity. In patients with end-stage ankle osteoarthritis with varus heel malposition as additional single-stage procedure complementing total ankle replacement. Severe peroneal tendinopathy with concomitant cavovarus deformity. CONTRAINDICATIONS: General surgical or anesthesiological risks, infections, critical soft tissue conditions, nonmanageable hindfoot instability, neurovascular impairment of the lower extremity, neuroarthropathy (e...
August 2015: Operative Orthopädie und Traumatologie
Elliot Sternthal, Patricia Underwood, Christos S Mantzoros
No abstract text is available yet for this article.
September 2015: Metabolism: Clinical and Experimental
Joshua D Valgardson, Maricruz Merino, Jamie Redgrave, James I Hudson, Margo S Hudson
OBJECTIVE: Recent guidelines recommend a physiologic approach to non-intensive care unit (ICU) inpatient glucose management utilizing basal-bolus with correctional (BBC) insulin over traditional sliding-scale insulin monotherapy. Unfortunately, few studies exist using a BBC approach restricted to human insulins (regular and neutral protamine Hagedorn [NPH]). This study evaluated changes in provider prescribing patterns, effects on blood glucose, and safety with implementation of hospital order sets for BBC using human insulins...
July 2015: Endocrine Practice
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