What to give if a patient has hyperglycemia (Point Of Care (POC) glucose 317 mg/dL)?

From the Guidelines

For a patient with a point-of-care (POC) glucose reading of 317 mg/dL, a basal-bolus regimen with rapid-acting insulin should be administered, considering the patient's specific sliding scale, insulin sensitivity, and medical history, as recommended by the most recent guidelines 1. The management of hyperglycemia in hospitalized patients is crucial to prevent adverse outcomes, including death 1.

Key Considerations

• Assess for symptoms of hyperglycemia, ensure adequate hydration, and investigate the cause of the elevated glucose.
• Recheck the glucose level 1-2 hours after insulin administration to ensure it's decreasing appropriately.
• If this is a new finding or represents a significant change from baseline, notify the physician as the patient's overall diabetes management plan may need adjustment.

Insulin Administration

• Rapid-acting insulin, such as lispro (Humalog), aspart (NovoLog), or glulisine (Apidra), can be administered subcutaneously, with a typical dose of 6-10 units, depending on the patient's specific sliding scale and medical history.
• The basal-bolus regimen is the preferred treatment for patients with good nutritional intake, as it allows for matching the prandial insulin dose to the amount of carbohydrate consumed 1.

Guidelines

• The 2021 guidelines for the management of diabetes and hyperglycemia in the hospital recommend a basal-bolus regimen for patients with severe hyperglycemia (BG >300 mg/dL) 1.
• The American Diabetes Association standards of medical care in diabetes also recommend insulin as the preferred therapy for persistent hyperglycemia (plasma blood glucose level >10 mmol/L [>180 mg/dL]) 1.

From the FDA Drug Label

Hyperglycemia (too much glucose in the blood) may develop if your body has too little insulin Hyperglycemia can be brought about by any of the following: Omitting your insulin or taking less than your doctor has prescribed. Eating significantly more than your meal plan suggests. Developing a fever, infection, or other significant stressful situation. In patients with type 1 or insulin-dependent diabetes, prolonged hyperglycemia can result in DKA (a life-threatening emergency)

The patient has a glucose level of 317, which is high.

• The patient likely has hyperglycemia.
• Insulin (IV) may be given to the patient, but the dosage and administration should be determined by a Health Care Professional.
• It is crucial to monitor the patient's blood glucose levels and adjust the treatment plan accordingly.
• The patient should be advised to follow their meal plan and insulin regimen as prescribed by their doctor. 2

From the Research

Treatment for Hyperglycemia

• The patient's glucose level of 317 indicates hyperglycemia, which can be a sign of diabetic ketoacidosis (DKA) or hyperglycemic hyperosmolar nonketotic syndrome (HHNS) 3, 4, 5, 6.
• Treatment for hyperglycemia typically involves replacement of fluid and electrolytes, as well as low-dose insulin therapy 3, 5.
• Intravenous insulin infusion can be used to manage inpatient hyperglycemia, with adjustments made based on ambient blood glucose level and magnitude of blood glucose change 7.

Management of Hyperglycemic Hyperosmolar Nonketotic Syndrome

• Hyperglycemic hyperosmolar nonketotic syndrome is characterized by extreme dehydration and neurologic symptoms, which are related directly to the degree of hyperosmolarity 3.
• Treatment involves careful evaluation and correction of the metabolic and volume status of the patient, identification and treatment of precipitating and comorbid conditions, and a smooth transition to a long-term treatment regimen 5.

Diagnostic Procedures

• Diagnostic procedures for hyperglycemia and related conditions include laboratory evaluation and differential diagnosis 3, 4.
• It is essential to identify the underlying cause of hyperglycemia and to manage any precipitating factors or comorbid conditions 3, 5.