Scribd Logo
Upload

Welcome to Scribd!

  • 1 views

    Non DM Npo Steroid Revapr18

    Uploaded by

    Pilgrim's Progress

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Non DM Npo Steroid Revapr18

    Uploaded by

    Pilgrim's Progress
    1 views2 pages

    Original Title

    Non Dm Npo Steroid Revapr18

    Copyright

    © © All Rights Reserved

    Available Formats

    PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    1 views2 pages

    Non DM Npo Steroid Revapr18

    Uploaded by

    Pilgrim's Progress

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 2

    STEPWISE APPROACH TO STEROID-INDUCED HYPERGLYCEMIA IN NON-CRITICALLY

    ILL PATIENTS WITHOUT PRE-EXISTING DIABETES WHO ARE ON NPO

    Monitor capillary blood glucose (CBG) at least once a day in all patients receiving
    steroid for at least 48 hours**

    All CBG readings < 140 CBG readings > 140


    mg/dL mg/dL

    Discontinue CBG Increase CBG monitoring to every 4 to 6


    monitoring if steroid hours
    dose expected to be
    stable

    CBG reading 140 – 180 CBG reading > 180


    mg/dL mg/dL

    > 20 units
    Start low-dose correctional insulin
    correctional insulin + required within 24
    hours

    No Yes

    Continue Start basal insulin


    existing
    management
    Estimate total daily doses (TDD) of insulin using any of the
    following methods:
    METHOD 1: Weight-based estimation = 0.1 to 0.2 units/kg/day *
    METHOD 2: Estimate daily dose from recent insulin infusions given

    Consider giving correctional rapid-acting insulin analog


    or regular insulin every 4 to 6 hours. +

    Adjust insulin doses according to glycemic responses by


    10-20% to reach target glucose levels. Decrease doses by
    20% in the event of hypoglycemia.

    Once steroids are tapered, decrease insulin doses


    by 10-20% for each 15% decrease in steroid dose
    1Glucose levels are predicted to rise 4-8 hours after oral steroids and sooner after IV steroids.
    2Steroid dose equivalents:

    Steroid Equivalent Dose in mg Duration of Action (hours)


    Hydrocortisone 20 8-12
    Prednisone 5 12-16
    Prednisolone 5 12-16
    Methylprednisolone 4 12-16
    Dexamethasone 0.75 20-36

    3Suggested glycemic goals: 140-180 mg/dL for the majority of non-critically ill hospitalized
    patients. For patients with terminal illness or a limited life expectancy or at high risk for
    hypoglycemia, consider a goal of < 200 mg/dL.
    4Above guidelines may not be applicable to patients receiving parenteral nutrition.

    + Below is a sample of a correctional insulin scale:


    CBG (mg/dL) Regular or rapid-acting insulin
    (units SQ)
    140 – 180 2
    181 – 220 4
    221 – 260 6
    261 – 300 8

    * Decrease TDD to 0.2 – 0.3 units/kg/day if with hypoglycemic risk factors such as: poor oral
    intake, acute or chronic renal insufficiency, hepatic impairment, sepsis, cognitive impairment
    and advanced age.

    References:
    1. Umpierrez GE et al. Management of hyperglycemia in hospitalized patients in non-critical care setting: An Endocrine Society
    Practice Guideline. J Clin Endocrinol Metab 2012, 97(1):16-38.
    2. American Diabetes Association. 15. Diabetes Care in the Hospital: Standards of Medical Care in Diabetes – 2020. Diabetes
    Care 2020 Jan; 43(Supplement 1):S193-S202.
    3. Draznin B. Managing Diabetes and Hyperglycemia in the Hospital Setting: A Clinician’s Guide. American Diabetes Association
    2016.
    4. Roberts A et al. Joint British Diabetes Societies for inpatient care. Management of Hyperglycemia and Steroid
    (Glucocorticoid) Therapy. 2014.
    5. Donihl, A et al. Endocr Pract 2006;12:358-262.
    6. Moghissi EC et al. American Association of Clinical Endocrinologists, American Diabetes Association. Endocrine Practice. 2009

    You might also like