Managing hyperglycemia in hospitalized patients.

Insulin infusion is used in the critical care setting for prevention of hyperglycemia and is administered most safely under a structured, dynamic, dose-defining algorithm. The ordering of basal-prandial-correction SC insulin therapy, appropriate for most hospitalized patients who are eating, is simplified and standardized to excellence by the development of institutional order sets or computerized order entry templates. Basal insulin therapy is prescribed as intermediate-acting insulin or long-acting insulin analogue. Prandial insulin therapy is delivered with meals to prevent excessive glycemic excursions from occurring after ingestion of meals and is prescribed as rapid-acting insulin analogue. Correction-dose insulin therapy is ordered as small doses of rapid-acting insulin analogue delivered to correct hyperglycemia and is prescribed with appropriate timing so as to avoid stacking with previously administered doses of rapid-acting insulin analogue. Patients knowledgeable in diabetes self-management will experience satisfaction under an institutional policy that allows self-management to continue under appropriate conditions during hospitalization. To craft appropriate institutional tools for patient care, the input and consensus of a multidisciplinary group of health care professionals, including primary care providers and hospitalists, as well as specialists in diabetes with backgrounds in endocrinology, nutrition and dietetics, nursing, pharmacy, laboratory sciences, and quality assurance, is required.