1. K. Ann Caudell, PhD, ACNP - BC

2. * Identify patients with out-of-range CBGs * Assist in maintaining CBGs between 80 mg/dL & 180 mg/dL during hospitalization * Assist teams with insulin treatment for newly diagnosed patients or those with continued elevated CBGs * Promote the appropriate use of basal bolus insulin * Assist teams in difficult glycemic control of patient with infections, taking steroids, high glucose dialysate, and those on tube feedings * Provide a safe transition from inpatient to outpatient glycemic control

3. * Weight-based calculation * Wt. X.2 for patients with renal insufficiency * Wt. X.3 -.5 for patients of normal weight * Wt. X.6 for patients overweight * Wt X.7 -.8 for obese patients For those patients newly diagnosed, start with conservative doses to determine patient’s sensitivity (or lack of ) to insulin.

4. * For patients on steroids, evaluate CBG trends * Frequently will have  CBGs throughout day * NPH recommended in this case to provide coverage for ~ 12 hours

5. * Infections  CBGs * Increased insulin requirements * Calculate total daily insulin requirements including correctional doses to determine basal and nutritional doses

6. * Represents a challenge for glycemic control * Issues include 1. temporary tube feeding catheters such as Dobhoffs due to frequency of occlusion or misplacement 2. nocturnal tube feedings when patient beginning to eat meals in that nutritional insulin is considered for meals but not during nighttime feedings * In this case, can continue to give correctional doses every four hours, or regular insulin every six hour

7. * When more permanent feeding tubes are inserted, can consider the following: 1. Determine patients insulin requirements and determine basal and nutritional doses 2. Nutritional dose options include: * Lispro every 4 hours * Regular every 6 hours * NPH every 12 hours * Eventually putting all insulin doses into the basal insulin * This requires careful monitoring 3. During periods of the patient being NPO, D5W should be administered at the rate of the tube feeding and all nutritional doses should be suspended

8. * K. Ann Caudell * Cell phone: 505-238-2849 * Pager: 951-2007 * Availability 9:00 AM to 1:00 PM * If after 1:00 PM, please contact internal medicine * Please either call my cell or page me if you need assistance.