The Hands-on Guide to Diabetes Care in Hospital
Hands-on Guides Series

3 am call: ?Mrs X has a blood sugar of 23. Come and deal with it?

?I think my insulin pen is called something like Solostar?

The respiratory doctors started high dose prednisolone, and the patient?s glucose is 18

?What is the blood glucose target for this patient admitted with an acute coronary syndrome??

Do you struggle with common diabetes problems in hospital practice? The Hands-on Guide to Diabetes Care in Hospital is an ideal companion for ward practitioners, providing answers to these and many other practical diabetes problems, helping you to deliver safe and effective care to patients.

Using the best current UK and international guidance, The Hands-on Guide to Diabetes Care in Hospital presents succinct guidance on acute diabetes problems, blood glucose management, acute medical and surgical problems commonly complicated by diabetes and insulin and non-insulin agents, as well as preparing for discharge to the community. With top tips, key points, questions to ask, treatment and follow-up advice in each chapter, this is an essential resource for all medical trainees and students who treat diabetic patients. Ward-based nurses, diabetes specialist nurses and pharmacists will also find a lot that is relevant to their practice.

Take the stress out of diabetes care with The Hands-On Guide!

www.wiley.com/go/handsonguides

Preface vii

Abbreviations x

Part 1 Basics 1

1 Classification of diabetes 3

2 Targets for glycaemic control in hospital 6

3 Diagnosis of diabetes in hospitalised patients 8

4 Nomenclature 10

5 Outline of physiology 13

6 Diabetes specialist nurses: roles and responsibilities 17

Part 2 Acute diabetes problems 19

7 History taking in patients with diabetes 21

8 Assessment and initial management of patients presenting with high blood glucose levels to an emergency department 26

9 Diabetic ketoacidosis (DKA) 32

10 Hyperosmolar hyperglycaemic state (HHS) 40

11 Managing acute hypoglycaemia in the emergency department 46

Part 3 Acute medical and surgical problems commonly complicated by diabetes 49

12 Presentation of cardiac disease in diabetic patients 51

13 Acute coronary syndromes and stroke 53

14 Secondary prevention after ACS 58

15 Acute pancreatitis 62

16 Infections in diabetes 66

Part 4 Insulin and non-insulin agents 85

17 Variable rate intravenous insulin infusion (VRIII, ‘sliding scale’ – UK; insulin drip – USA) 87

18 Converting from VRIII to subcutaneous insulin 90

19 Writing safe insulin prescriptions 91

20 Insulin preparations in the UK 92

21 Commonly used insulin regimens 95

22 Emergency subcutaneous insulin regimens 100

23 Insulin substitutions in emergency settings 102

24 Non-insulin agents 104

Part 5 Blood glucose management on the wards 109

25 Managing patients you are asked to see with high blood glucose levels 111

26 Managing acute hypoglycaemia on the wards 115

27 Perioperative management of elective surgery 119

28 Enteral feeding 123

29 Glucocorticoid treatment 126

30 Safe discharge of diabetic patients from hospital 128

Part 6 Important odds and ends 131

31 Technology in diabetes 133

32 Inpatient screening schedule 142

33 Practical procedures 144

34 On-call guide to hyperglycaemic emergencies 154

Index 157