From the Research
For a diabetic patient with hyperglycemia 1 hour after receiving 12 units of Actrapid (insulin aspart), I recommend administering an additional dose of insulin aspart and increasing the frequency of monitoring, as the elevated blood sugar indicates that the initial insulin dose was insufficient to adequately control the patient's glycemic levels. The patient should continue their prescribed insulin regimen but with closer monitoring every 2-3 hours until blood glucose stabilizes below 180 mg/dL. According to the study by 1, a basal-bolus regimen with insulin analogues, such as insulin aspart, is effective in managing hyperglycemia in hospitalized patients with type 2 diabetes. The study found that the basal-bolus regimen with insulin analogues resulted in equivalent glycemic control and frequency of hypoglycemia compared to treatment with human insulin. However, the study by 2 highlights the importance of individualizing insulin therapy and adjusting the dose based on the patient's response to treatment. The goal is to gradually bring blood glucose to target range (80-130 mg/dL fasting, <180 mg/dL post-meal) while avoiding rapid drops that could lead to hypoglycemia. Some key points to consider when managing hyperglycemia in diabetic patients include:
- Monitoring blood glucose levels regularly to adjust the insulin dose as needed
- Using insulin analogues, such as insulin aspart, which have a faster onset of action and a shorter duration of action compared to human insulin
- Adjusting the insulin dose based on the patient's response to treatment and their individual needs
- Encouraging the patient to drink sugar-free fluids to stay hydrated
- Avoiding rapid drops in blood glucose levels that could lead to hypoglycemia. It is also important to note that the study by 3 found that adding basal insulin to oral agents was more effective and safer than switching to twice-daily premixed insulin in type 2 diabetic patients insufficiently controlled by oral antidiabetic agents. However, this study used insulin glargine, which is a long-acting basal insulin analogue, whereas the patient in question is receiving insulin aspart, which is a rapid-acting insulin analogue. Therefore, the results of this study may not be directly applicable to the patient's situation. In general, the management of hyperglycemia in diabetic patients requires a comprehensive approach that takes into account the patient's individual needs and response to treatment, as well as their overall health status and medical history. By following these principles and adjusting the insulin dose as needed, it is possible to effectively manage hyperglycemia and prevent complications in diabetic patients.