Pharmacists' role in glycemic management in the inpatient setting: An opinion of the endocrine and metabolism practice and research network of the American College of Clinical Pharmacy.
Diabetes Mellitus; hyperglycemia; hypoglycemia; inpatients; pharmacists
The objective of this opinion paper was to identify and describe the role of pharmacists in ensuring safe and optimal management of patients with glycemic excursions in the inpatient setting. The role of the pharmacist includes involvement in admission medication history and reconciliation, formulary management of glucose‐lowering medications and devices, individual patient medication management, discharge transition of care, and interprofessional collaboration with other health care providers. Recommendations are based on review of published guidelines and literature focusing on the management of patients with hypo‐ and hyperglycemia in the hospital as well as during the time of transition to and from the inpatient setting. [ABSTRACT FROM AUTHOR]
Donihi Amy C; Moorman John M; Abla Alicia; Hanania Raja; Carneal Dustin; MacMaster Heidemarie Windham
JACCP: Journal of the American College of Clinical Pharmacy
2019
2019-04
<a href="http://doi.org/10.1002/jac5.1041" target="_blank" rel="noreferrer noopener">10.1002/jac5.1041</a>
BRITTLE DIABETES TREATED WITH INTENSIFIED THERAPY AND A POCKET INSULIN DOSAGE COMPUTER
adjustment; brittle diabetes; Endocrinology & Metabolism; hypoglycemia; intelligence; intensive insulin therapy; medical artificial; medical computers; Nutrition & Dietetics; optimum diabetes therapy; quality-of-life; uncontrolled diabetes
Brittle diabetes is a therapeutic challenge. The first experience with a pocket Insulin Dosage Computer (IDC(TM)) in brittle diabetes was conducted in the form of a clinical N-of-1 trial. After intensified conventional therapy (ICT) the patients used the insulin dosage computer (ICT+IDC), and then the IDC was withdrawn (ICT-IDC). During ICT+IDC therapy, weekly pre-prandial mean blood glucose levels, glycohemoglobin levels and quality of life were all significantly improved. Hypoglycemia was eliminated. When the IDC was withdrawn (ICT-IDC), metabolic control deteriorated. The 2-tailed p value was used for statistical analysis.
Sakkal S
Diabetes Nutrition & Metabolism
1993
1993-04
Journal Article
n/a
Critical low catastrophe: a case report of treatment-refractory hypoglycemia following overdose of long-acting insulin.
BLOOD sugar; DEXTROSE; HYPOGLYCEMIA; INSULIN; INSULINOMA; PARENTERAL infusions
Overdose of long-acting insulin can cause unpredictable hypoglycemia for prolonged periods of time. The initial treatment of hypoglycemia includes oral carbohydrate intake as able and/or parenteral dextrose infusion. Refractory hypoglycemia following these interventions presents a clinical challenge in the absence of clear guidelines for management. Octreotide has sometimes been used, but its use is generally limited to sulfonylurea overdose. In this case report, we present a case of refractory hypoglycemia following an overdose of 900 units of long-acting insulin glargine that failed to respond to usual modes of therapy mentioned above. Stress-dose corticosteroids were then initiated, followed by subsequent improvement in IV dextrose and glucagon requirements and blood glucose levels. Hence, corticosteroids may serve as an adjunctive therapy in managing hypoglycemia and can be considered earlier in the course of treatment in patients with refractory hypoglycemia to prevent volume overload, especially when large volumes of dextrose infusions are required.
Sandooja R;Moorman JM;Priyadarshini KM;Detoya K
Case Reports in Endocrinology
2020
1905-07
journalArticle
<a href="http://doi.org/10.1155/2020/8856022" target="_blank" rel="noreferrer noopener">10.1155/2020/8856022</a>