Inpatient Diabetes Management

# Type *** Diabetes
Checklist
‍-- Chart Check:  baseline BG, most recent A1c, home med regimen, h/o DKA, previous complications (neuropathy, LE ulcers, nephropathy/CKD, retinopathy/vision changes, gastroparesis)
-- HPI Intake: foot ulcers/wounds, polyuria, abd pain, previous complications (neuropathy, LE ulcers, nephropathy/CKD, retinopathy/vision changes, gastroparesis)
-- Can't Miss: DKA
-- Admission Orders: hold home oral meds, sliding scale, accuchecks, A1c if nothing in chart for last 3-6 months

Plan:
Workup
-- New diagnosis - BMP, A1c, lipids, urine microalbumin

Treatment
-- holding home ***
-- if home insulin regimen - dose reduce 25-50% depending on PO intake and degree of presenting illness
-- if no home insulin regimen - 0.3-0.4 units per kg of body weight initially vs total insulin used via a sliding scale -> divide into 50% basal, 50% bolus
-- Prandial/Bolus: *** units [before meals vs q6 if NPO]
-- Long-Acting: *** units qhs
-- Sliding Scale: *** [low/medium/high]
-- accuchecks ***
-- If insufficient control, basal increase 10-20% every 2-3 days, prandial increase 1-2 units/dose every 1-2 days 
-- further adjustments: if AM is high, increase basal; if pre AM meal is high, increase AM bolus; if bedtime is high, increase PM meal bolus; If NPO, 25-50% dose reduction in basal insulin and take off prandial
-- Neuropathy: *** First Line - Pregabalin (Lyrica) 300-600mg divided BID, gabapentin (neurontin) 1200-3600 divided TID, amitriptyline 10-150 qhs, duloxetine (cymbalta) 60-120mg daily or divided BID, Second Line - venlafaxine 150-225mg daily, tramadol 50-100q4-6 (max 400 per day), Additions - lidociane patch, capsaicin cream
-- Consider endocrine consult for assistance with complex pts with labile sugars