What is an acceptable Random Blood Sugar (RBS) level for discharge in a patient with uncontrolled Diabetes Mellitus (DM) who has been given subcutaneous (SC) Insugen (human insulin)?

Acceptable Random Blood Sugar Levels for Discharge in Patients with Uncontrolled Diabetes

For a patient with uncontrolled diabetes who has received subcutaneous insulin (Insugen), a random blood sugar level below 180 mg/dL (10 mmol/L) is generally acceptable for discharge, provided there are no other complications requiring hospitalization. 1

Discharge Criteria Based on Blood Glucose Levels

Target Blood Glucose Levels

• Non-critically ill patients:
  • Target range: <180 mg/dL (10 mmol/L) 1
  • Avoid discharge if blood glucose remains consistently >180-200 mg/dL 1

Decision Algorithm Based on Blood Glucose Control

1. Well-controlled (RBS <180 mg/dL):

   • Safe for discharge with appropriate follow-up
   • Ensure patient has clear discharge instructions and medication plan

2. Moderately elevated (RBS 180-200 mg/dL):

   • May be acceptable for discharge if:
     • Trending downward from admission values
     • Patient can self-monitor glucose
     • Has appropriate follow-up arranged
     • No signs of acute complications

3. Poorly controlled (RBS >200 mg/dL):

   • Consider extending hospitalization
   • Adjust insulin regimen before discharge
   • If persistent despite treatment, consult endocrinology 1

4. Severely elevated (RBS >300 mg/dL):

   • Not appropriate for discharge
   • Requires further insulin adjustment and monitoring

Additional Discharge Considerations

HbA1c-Based Recommendations

• HbA1c <8%: Schedule follow-up with primary care within one month 1
• HbA1c 8-9%: Arrange consultation with diabetologist 1
• HbA1c >9% or unstable blood sugars >200 mg/dL (11 mmol/L): Consider specialist consultation before discharge 1

Insulin Regimen at Discharge

• Ensure appropriate transition from hospital insulin regimen to home regimen
• For patients new to insulin: Calculate total daily dose based on hospital requirements 2
• Provide clear instructions on basal and prandial insulin dosing

Hypoglycemia Risk Assessment

• Ensure no recent hypoglycemic episodes before discharge
• Verify patient understands hypoglycemia symptoms and management
• Reduce insulin dose by 10-20% if hypoglycemic episodes occurred 2

Common Pitfalls to Avoid

1. Relying solely on sliding scale insulin for discharge planning - this approach is ineffective and not recommended for ongoing management 1

2. Discharging patients with significantly elevated blood glucose (>200 mg/dL) without adequate follow-up plan

3. Failing to educate patients about glucose monitoring, medication administration, and when to seek medical attention

4. Not considering patient's ability to manage diabetes at home, including access to medications and monitoring supplies

5. Ignoring hyperglycemia in elderly patients - studies show this is a common problem that can lead to complications 3

Remember that random blood glucose is a robust risk factor for diabetes complications 4, and proper management at discharge can prevent unscheduled hospital readmissions 5.