Need evidence based practice help

[dking821]

I am look for some evidence based practice to support or not support:

the facilty where I work when a diabetic patient is admitted they forego the pt's home regime and start them on accuchecks ac and hs and novolog premeal.

Some of our patients have never been on insulin before and prior to hospitalization were controlled with oral hypoglycemics. Also some were never doing accuchecks as often as we are doing them in the hospital. If you could point me in the direction of some resources to support this I would greatly appreciate it. Thanks.

[SHGR, MSN, RN, CNS]

If you are on Medscape, try this article- I just did a quick Medscape search for "blood glucose testing inpatient" Medscape: Medscape Access

"A new clinical practice guideline (CPG) from the Endocrine Society, published in the January 2012 issue of the Journal of Clinical Endocrinology and Metabolism, recommends blood glucose testing for all patients on admission to a hospital and describes optimal management of hyperglycemia in patients not requiring intensive care." A 2012 article! :)

[mammac5]

There is a lot of literature out there concerning inpatient insulin use - you can find LOADS by using Google Scholar.

Oral hypoglycemics are usually held on admission due to the following reasons:

Metformin is held because a patient may need procedures or studies that involve the use of contrast dye; metformin is contraindicated in these cases. It is also difficult to determine how well a patient will drink or have fluids during hospitalization and there is increased risk of lactic acidosis in patients who are dehydrated and using metformin.

Sulfonylureas (glipizide, glyburide) are held due to their known contribution to hypoglycemia. Again, the patient may be well managed on this at home but we know oral intake is unpredictable in the hospital. Once these meds are in the system they stick around for some time; meaning that a patient may have a low blood sugar that is very difficult to treat and may need IV dextrose if he/she is unable to take po due to lack of desire, NPO status, or unconsciousness.

It is typical to hold these meds and put the patient on insulin and someone should explain to the patient the reasons for this, as well as (if they were well-managed at home with a reasonable A1c on admission) the fact that they can likely go back to their previous regimen on DC and won't need to continue insulin.

We use a basal insulin (Lantus or Levemir) and then a rapid-acting mealtime analog (Humalog or Novolog, for instance) for patients who are having good po intake.