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  • GUIDELINES FOR MANAGING DIABETES

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    thapan
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    1. The guidelines provide an algorithm for managing hyperglycemia in type 2 diabetes, starting with lifestyle modifications and progressing to adding oral medications and basal insulin as needed. 2. For management of diabetic ketoacidosis (DKA), the guidelines recommend initial evaluation and IV fluids and insulin administration. Hydration status and electrolyte levels should be monitored closely. 3. When the patient's condition is stabilized with a serum glucose of 250 mg/dL, the guidelines recommend changing to IV dextrose and saline with adequate insulin to maintain glucose between 150-200 mg/dL until metabolic control is achieved.

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    dka

    Original Title

    MAP_DKA

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    1. The guidelines provide an algorithm for managing hyperglycemia in type 2 diabetes, starting with lifestyle modifications and progressing to adding oral medications and basal insulin as needed. 2. For management of diabetic ketoacidosis (DKA), the guidelines recommend initial evaluation and IV fluids and insulin administration. Hydration status and electrolyte levels should be monitored closely. 3. When the patient's condition is stabilized with a serum glucose of 250 mg/dL, the guidelines recommend changing to IV dextrose and saline with adequate insulin to maintain glucose between 150-200 mg/dL until metabolic control is achieved.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    43 views1 page

    GUIDELINES FOR MANAGING DIABETES

    Uploaded by

    thapan
    1. The guidelines provide an algorithm for managing hyperglycemia in type 2 diabetes, starting with lifestyle modifications and progressing to adding oral medications and basal insulin as needed. 2. For management of diabetic ketoacidosis (DKA), the guidelines recommend initial evaluation and IV fluids and insulin administration. Hydration status and electrolyte levels should be monitored closely. 3. When the patient's condition is stabilized with a serum glucose of 250 mg/dL, the guidelines recommend changing to IV dextrose and saline with adequate insulin to maintain glucose between 150-200 mg/dL until metabolic control is achieved.

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    © All Rights Reserved
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    GUIDELINES FOR MANAGEMENT OF DIABETES MELLITUS

    Summary of algorithm for management of


    hyperglycaemia in type 2 diabetes.
    If uncontrolled (HbA1C >= 7%) move promptly to
    next level of therapy

    Management of adult patients with DKA


    Complete initial evaluation. Start IV fluids: 1.0 L of 0.9% NaCl per hour initially (15 20 ml/kg/hr).

    IV Fluids

    Insulin

    Determine hydration status

    Hypovolaemic
    shock

    Mild
    hypotension

    Hemodynamic
    monitoring

    Administer
    0.9% NaCl
    (1.0 L/h)
    and/or plasma
    expander
    Evaluate corrected serum Na

    Serum Na
    high

    Serum Na
    normal

    0.45% NaCl
    (4 14
    ml/kg/h)
    depending on
    hydration
    state

    pH <6.9

    IV Route
    Cardiogenic
    shock

    +1

    Insulin:
    Regular 0.15
    units/kg as IV
    bolus

    Assess Need for


    Bicarbonate

    Potassium

    If initial serum K+ is <3.3


    mEq/L hold insulin and
    give 40 mEq K+ per hr.
    (2/3 KCl and 1/3 KPO4)
    until
    K >= 3.3 mEqL

    pH 6.9 7.0

    Lifestyle modifications

    pH >7.0

    Uncontrolled

    NaHCO3
    (100 mmol)
    dilute in
    400ml DW*.
    Infuse at
    200ml/hr

    NaHCO3
    (50mmol)
    dilute in
    200ml DW*.
    Infuse at
    200ml/hr

    No
    HCO3

    Add
    SU / MF

    Uncontrolled
    0.1 units/kg/h
    IV insulin
    infusion

    If initial K+ >= 5.0


    mEq/L do not give K+,
    but check K+ every 2hr

    Repeat HCO3
    administration every 2hr
    until pH > 7.0. Monitor
    serum K+

    Add
    SU / MF

    Add
    Basal
    Insulin

    Add
    TZD

    Serum Na low

    0.9% NaCl
    (4 14
    ml/kg/h)
    depending on
    hydration
    state

    If serum glucose
    does not fall by 50
    70 mg/dl in first
    hour

    If initial serum K+ is
    >=3.3 mEq/L but <5.0
    mEq/L give 20 30 mEq
    K+ in each liter of IV
    fluid (2/3 as KCl and 1/3
    as KPO4 ) to keep serum
    K+ at 4.5 mEq/L

    Uncontrolled

    Add
    TZD

    Double insulin infusion


    hourly until glucose
    falls by 50 70 mg/dl

    Intensify
    Insulin

    Add
    basal
    Insulin

    Add
    SU / MF

    Uncontrolled

    Further intensify Insulin or add


    basal Insulin + metformin +/- TZD*

    When serum glucose reaches 250 mg/dl

    Change to 5% dextrose with 0.45% NaCl at 150-250 ml/h with


    adequate insulin (0.05 0.1 units/kg/h IV infusion or 5 10
    units SC every 2h) to keep the serum glucose between 150
    and 200 mg/dl until metabolic control is achieved.

    Add
    basal
    Insulin

    Check electrolytes, BUN, creatinine and glucose every 2 4 h until


    stable. After resolution of DKA, if the patient is NPO, continue IV
    insulin and supplement with SC regular insulin as needed. When the
    patient can eat, initiate a multidose insulin regimen and adjust as
    needed. Continue IV insulin infusion for 1 2 h after SC insulin is
    begun to ensure adequate plasma insulin levels. Continue to look for
    precipitating cause(s).

    Key:

    SU = sulphonylurea
    TZD = thiazolidinedione
    * TZD with insulin may worsen Cardiac Failure

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