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Cardio Diabetes Medicine 2017 549

7. Maintain the same correct infusion rate when the BG is 140 to 180 mg/Dl

INSULIN INFUSION SC INSULIN
1. RBG should be maintained in 140 – 180 mg/ dL for at least 6 hours prior to SC Insulin transition
2. Insulin requirement for the past 6 hours x 4 = TDD -80% New TDD for SC Insulin !
3. 50-80 % Basal (Higher for fasting pts)

4. 20-50 % divided Bolus
5. Give Rapid insulin 1 – 2 hrs BEFORE stopping the infusion
6. Give Long acting insulin 2 – 3 hrs BEFORE stopping the infusion

CARRY HOME MESSAGE
1. EAT RIGHT DIABETIC DIET WITH LSM
2. STRESS MANAGEMENT & ADEQUATE SLEEP REDUCES 25% OF HYPERGLYCEMIA

3. A1c TARGET <6.5 -8.5%-PATIENT CENTERED APPROACH
4. USE METFORMIN MAX. DOSE EVEN 2.850 gm / DAY UNLESS CONTRAINDICATED
5. USE MAXIMUM PHYSIOLOGICAL INSULIN BEFORE STARTING PARENTRAL INSULIN
6. USE ANALOG OR HUMAN INSULIN EARLY IF NOT ACHIEVED GLYCEMIC TARGETS

7. PREMIXED INSULINS AND PREFILLED INSULIN PENS SHOULD BE USED INSTEAD OF MIXING INSU-
LINS IN ELDERLY DIABETICS
8. HYPOGLYCEMIA & HYPOTENSION ARE MORE DANGEROUS THAN HYPERGLYCEMIA & HYPERTENSION

RESOURCES
1. AACE GUIDELINES 2017
2. STANDARDS OF MEDICAL CARE IN DIABETES - 2017, ADA
3. ADA GUIDELINES 2017
4. CANADIAN GUIDELINES 2017
5. BREMER JP ET AL. DIABETES CARE. 2009; 32 (8):1513-17

Cardio Diabetes Medicine