1. CASES
Inpatient Diabetes

2. Mr. L
41 yo male with LADA x 3 years, underwent cardiac surgery unable to extubate, requiring continuous TF. Home insulin Glargine/Lantus 10 units Lispro/Humalog 2 units TID AC. HgA1c 7.2% Hb 14.
SICU asking for recommendations to d/c off IV Insulin

3. Mr. G - 20 yo Hispanic male with ALL Day 4 BMT requiring TPN r/t oral mucoscitis on Cyclosporine 130mg IV q 12h. BMI 29.4 (84.9kg) BG 112 on admit. Drinking only water, sips of gatorade r/t pain with swallowing. IV insulin started yesterday r/t hyperglycemia despite adding 40 units of Regular Insulin in TPN with 530mL Dextrose 50% .
Team is asking for recommendations to d/c IV Insulin

4. Sally Saucer
56 yo F with Hx of bladder CA s/p ileal conduit POD 10, re-admitted for fever/chills. PMH includes DMT2 x 12y. She’s eating but feels “sick.” BG now SMBG at home range ’s. HgA1c 6.7% Hb 13. Surgical team continued home diabetes medications on admission.
Lantus/Glargine 40 units qam
Glyburide 2.5mg
Metformin 1000mg BID
Victoza/Liraglutide 1.8mg daily
What recommendations do you give the team during morning rounds?

5. Mr. H.
41 yo male with hx of T2DM x 5 years on Metformin 1gm BID with pre-op HgA1c 8.4%, s/p myomectomy and Maze procedure, off vasopressors, plans to transfer to telemetry unit. D5 ½ NS 100mL/hour. Only taking bites of food but now ravenous and plans to order large breakfast. Creatinine is 1.0 GFR >60
Team is asking for recommendations off IV insulin?
He is expected to discharge in 1-2 days, what are your plans for discharge?

6. Ms. P.
Ms. P. comes back pre BMT. Her consolidation chemo includes Dexamethasone 40mg BID x 3 more days. She was started on IV insulin with NS IVF over night. She’s now complaining about hourly blood glucose monitoring and requests to be off IV insulin. Ate only breakfast today - eggs, bacon and black coffee. Has a full appetite.
Team is asking for recommendations off IV insulin

7. Ms. A
60 yo Vietnamese female with no hx of diabetes with admitted for COPD exacerbation requiring Prednisone 25mg daily. Her sister has “diet controlled diabetes.” Works as a CPA. BMI 24. HgA1c 6.3% on admit. Planning taper by 5mg every 1 week after discharge.
What type of diabetes is this?
What is the BG target during hospitalization?
What changes will you make to insulin regimen?
What will you consider for discharge?
Fasting BG
Pre-Lunch BG
Pre-Dinner BG
HS BG
129
157
218
226
+2u Lispro

8. Mr. V.
54 yo Filipino male with SCC s/p hemi-mandibulectomy POD 2, hx of T2DM x 4 years on Metformin 1gm BID but has not been taking because unable to swallow pills related to cancer. PMH CKD with Iron Deficiency Anemia. Will require bolus TF qid = 262 gm of CHO per day, until able to tolerate nutrition by mouth. HgA1c 6.4% Hb 12. Crt Lives in Covington, with wife who is an RN. Does not check BG at home.
What will you recommend for remainder of hospitalization?
What will you consider for discharge?
Pre-BOLUS BG
188
268
218
293
+3u Lispro
+2u Lispro