What management plan is recommended for a patient with normal blood glucose levels?

Management of Patients with Normal Blood Glucose Levels

For patients with normal blood glucose levels, routine monitoring should continue with no immediate intervention required, as maintaining blood glucose within target range (70-180 mg/dL) is the goal of diabetes management.

Assessment and Monitoring Approach

For Hospitalized Patients

• For hospitalized patients with normal glucose levels (70-180 mg/dL), continue monitoring according to clinical status 1:
  • For patients who are eating: Point-of-care (POC) glucose monitoring before meals
  • For patients not eating: POC glucose monitoring every 4-6 hours
  • For patients on intravenous insulin: More frequent monitoring (every 30 min to 2 hours)

For Outpatients

• For patients with diabetes with normal glucose readings:
  • Type 1 diabetes: Continue monitoring at least three times daily 1
  • Additional testing recommended before and after exercise, before driving, and when uncertain about glucose levels
  • Bedtime testing is particularly important to prevent nocturnal hypoglycemia

Management Recommendations Based on Specific Glucose Values

Bedtime Glucose Management 2

• For bedtime glucose 100-180 mg/dL: No carbohydrate snack needed if on insulin
• For bedtime glucose 70-100 mg/dL: Consider a small bedtime snack with reduced carbohydrate content
• For bedtime glucose <70 mg/dL: Provide a standard bedtime snack containing both carbohydrate and protein

Perioperative Management

For patients with normal glucose undergoing surgery 1:

1. Target perioperative blood glucose range: 100-180 mg/dL (within 4 hours of surgery)
2. Continue monitoring every 2-4 hours while NPO
3. Hold metformin on day of surgery
4. SGLT2 inhibitors must be discontinued 3-4 days before surgery
5. Hold oral glucose-lowering agents morning of surgery
6. Adjust insulin dosing: give half of NPH dose or 75-80% of long-acting analog/basal insulin

Special Considerations

Preventing Hypoglycemia

• If blood glucose drops below 100 mg/dL at bedtime, patient should eat a small snack 1
• Bedtime snacks are largely unnecessary to raise blood glucose if a patient uses insulin and has normal levels, but they may be necessary if the patient's blood glucose level is low 1, 2

Technology Utilization

• Consider continuous glucose monitoring (CGM) for patients with:
  • History of hypoglycemia unawareness
  • Frequent glucose fluctuations
  • Need for tighter control without increased hypoglycemia risk 3, 4

Transition of Care

For hospitalized patients with normal glucose being discharged 1:

1. Structured discharge plan tailored to individual needs
2. Follow-up appointment with primary care provider, endocrinologist, or diabetes educator within 1 month
3. If medications were changed during hospitalization, earlier follow-up (1-2 weeks) is preferred

Common Pitfalls to Avoid

1. Overtreatment: Avoid unnecessary interventions for glucose values within target range (70-180 mg/dL)
2. Inaccurate readings: Be wary of potentially inaccurate blood glucose readings from faulty equipment or improper testing techniques 1
3. Ignoring patterns: Even with normal readings, monitoring for patterns and variability remains important 5
4. Neglecting follow-up: Normal readings don't eliminate the need for regular medical follow-up and A1C monitoring

Key Takeaway

Normal blood glucose readings (70-180 mg/dL) represent the target of diabetes management. The focus should be on maintaining this range through continued monitoring and appropriate lifestyle management, while avoiding unnecessary interventions that could lead to hypoglycemia or hyperglycemia.