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Managing Inpatient Blood Glucose

Managing Inpatient Blood Glucose

Research indicates that hyperglycemia is a common finding among both medical and surgical patients, regardless of whether or not they have diabetes. When compared with patients who have normal glycemic levels, those with uncontrolled hyperglycemia have higher mortality and morbidity. These patients tend to have: • Delays in healing. • Poor immune responses. • Higher risks for cardiovascular events, inflammatory issues, and thrombosis. The extra care associated with these issues can increase healthcare costs unnecessarily. Need for Changes Many hospitals in the United States have protocols intended to implement intensive insulin therapy routinely in critically sick patients. However, based on new evidence, Amir Qaseem, MD, PhD, MHA, FACP, warns that physicians should not use intensive insulin therapy to strictly control blood glucose in hospitalized patients with or without diabetes. According to Dr. Qaseem, a potentially major harm in using intensive insulin therapy is that it can increase the risk of hypoglycemia. “This can lead to the same poor outcomes and adverse effects that we try to avoid with efforts to prevent or treat hyperglycemia,” he says. “Physicians should avoid aggressive glucose management and instead target levels of 140 mg/dL to 200 mg/dL when using insulin therapy.” Finding Balance To help clinicians find a balance between hyper­glycemia and hypoglycemia, Dr. Qaseem and colleagues at the American College of Physicians (ACP) reviewed recently published studies and developed recommendations on inpatient glycemic control. The document was published in the American Journal of Medical Quality. The first recommendation made by the ACP committee was that clinicians should avoid intensive insulin therapy to strictly control blood glucose or to normalize blood glucose in surgical...
Takin’ It to the Streets: New Recommendations for Driving & Diabetes

Takin’ It to the Streets: New Recommendations for Driving & Diabetes

Nearly 19 million people in the United States have diagnosed diabetes, and many of these individuals will seek or presently hold a license to drive. Currently, states have different laws concerning driving and diabetes. “For people with diabetes, a driver’s license is essential for many reasons, including getting to and from work or school, caring for themselves and/ or family members, and many other daily life functions,” says Daniel Lorber, MD, FACP, CDE. “This is an important issue because there has been considerable debate on the role of diabetes and its relevancy on determining driver ability and eligibility for a license.” He adds that each state has its own laws on disclosure of diseases that may impact patients’ driving ability, further complicating the issue. Click here to view our new Diabetes Update ebook. Research suggests most people with diabetes can and do drive safely, but in the past, there have been inappropriate attempts to restrict driving licensure for these patients. “The chief concern about driving with diabetes is hypoglycemia because these episodes can cause confusion and disorientation,” Dr. Lorber says. However, while hypoglycemic episodes can affect driving ability, the available data show that these incidents are uncommon. Other factors related to diabetes that could affect driving include retinopathy and peripheral neuropathy.   New Guidance In the January 2012 issue of Diabetes Care, the American Diabetes Association released a position statement based on current scientific and medical evidence addressing the issue of driving in patients with diabetes. The statement advises against blanket restrictions and instead recommends that patients who have issues that could increase driving risks be assessed by physicians...
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