ResearchPerspectives in PracticeInpatient Management of Diabetes and Hyperglycemia: Implications for Nutrition Practice and the Food and Nutrition Professional
Section snippets
The Evidence for Improved Inpatient Glycemic Control
Hyperglycemia itself has been linked to poor outcomes in hospitalized patients (1, 3). Hyperglycemia has been associated with immunosuppression, negative effects on the cardiovascular system, blood pressure changes, catecholamine elevations, platelet abnormalities, electrophysiologic changes, brain ischemia, and changes in the vascular endothelial cells (1, 3). In addition, thrombosis associated with hyperglycemia may explain the increased thrombotic events commonly seen in hospitalized
Implications of Glycemic Targets on Medical Care
Achieving blood glucose targets requires that all members of the health care team work together to develop, review, and/or maintain standards and protocols on the following topics (1):
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Screening for hyperglycemia on admission and/or identification of hyperglycemia during hospitalization.
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Guidelines for discontinuation of oral diabetes medications for individuals with diagnosed diabetes, and use of insulin therapy, as appropriate, for all patients with hyperglycemia.
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Integration of blood glucose
The Goals of MNT for Hospitalized Diabetes Patients
MNT is an essential component of diabetes management for persons with diabetes (18) and thus should be integrated with the medical treatment plan. MNT includes an assessment of nutritional status and the provision of diet modification, counseling, or specialized nutrition therapy (19). Implementing MNT, however, can be challenging when the person with diabetes is hospitalized. Individualization of MNT during hospitalization, along with intensive medical management, is required if individuals
Use of a Consistent Carbohydrate Diet in Inpatient Settings
The consistent carbohydrate meal planning system for hospitals was developed to provide a practical way of serving food to diabetes patients in a hospital setting while improving metabolic control (22). This system is not based on specific calorie levels, but on the amount of carbohydrate at each meal or snack. The carbohydrate amount is consistent from meal to meal and day to day with the focus on the total amount of carbohydrate in a meal (22). The primary sources of carbohydrate are fruits,
Special Nutrition Issues and Considerations for Inpatient Settings
In the hospital setting, it is often difficult for patients to follow their usual food plan and in many cases their oral intake is less than usual. Barriers that may impact an individual’s nutrition status include: increased nutrient and calorie needs due to catabolic stress, variation in medications, illness-induced appetite suppression, and the possible need for enteral or parenteral nutrition support. Use of nutrition supplements or nutrition support may be required to meet the person’s
Liquid and Progression Diets
Noncaloric (sugar-free) liquid diets are not appropriate for individuals with diabetes or illness-induced hyperglycemia. Calories and carbohydrates are needed to meet increased glucose requirements during illness and surgery (22). Individuals on clear or full liquid diets should receive approximately 200 g of carbohydrate throughout the day divided in equal amounts at meals and snack times to prevent starvation ketosis (25, 26, 27, 28, 29) (Table 2). Advancing from clear liquid to full liquid
Implications of Glycemic Targets for Food and Nutrition Professionals
Achieving blood glucose targets requires that food and nutrition professionals work with other members of the health care team, utilizing a quality improvement approach, to address nutritional issues that may impact a patient’s ability to achieve glycemic control. Food and nutrition professionals need to not only make recommendations for change, but assess the outcomes of these changes and make additional recommendations. Key areas of focus to improve inpatient glycemic control are:
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Screening
J. L. Boucher is director, Health Programs and Performance Measurement, HealthPartners, Health Behavior Group, Minneapolis, MN.
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Cited by (34)
Part II: Managing perioperative hyperglycemia in total hip and knee replacement surgeries
2014, Nursing Clinics of North AmericaCitation Excerpt :Furthermore, persistent hyperglycemia in the hospitalized patient should be managed like DM.14,15 The evidence supported a premeal BG level less than 100 mg/dL and a postprandial level less than 180 mg/dL as an ideal target.14 However, avoidance of hypoglycemia when using insulin to manage hyperglycemia was emphasized repeatedly, especially while the patient is not yet consuming food or drink.1,2,16
Nutrition management of diabetes in acute care
2014, Canadian Journal of DiabetesCitation Excerpt :Clear- and full-fluid diets should provide no fewer than 130 grams per day and ideally closer to 200 grams of carbohydrate daily, distributed throughout the meals. Non-caloric fluids and sugar-free liquid diets are not appropriate (13). Despite research to suggest otherwise, many patients are put on postoperative diet progressions that move from NPO status through a clear-fluid diet to a regular therapeutic diet in an as-tolerated manner.
Implementing and evaluating a multicomponent inpatient diabetes management program: Putting research into practice
2012, Joint Commission Journal on Quality and Patient SafetyCitation Excerpt :A fundamental, but often overlooked, component of MNT in hospitalized patients with diabetes involves ensuring the delivery of diet trays consistent with the carbohydrate-controlled diet order entered by the provider. Variability of carbohydrate intake from meal to meal due to poor appetite or nothing per os (NPO; nothing by mouth) status often contributes to dysglycemia in the inpatient setting.21,23 Quality control in meal preparation is hampered by the fact that dietary staff often work in entry-level positions with high turnover rates at our hospital.
Inpatient Management of Diabetes and Hyperglycemia
2023, The Diabetes Textbook: Clinical Principles, Patient Management and Public Health Issues, Second EditionRole of the Diabetes Educator in Inpatient Diabetes Management
2019, Diabetes Educator
J. L. Boucher is director, Health Programs and Performance Measurement, HealthPartners, Health Behavior Group, Minneapolis, MN.
C. S. Swift is dietetics coordinator, Walla Walla Veterans Affairs Medical Center, Walla Walla, WA.
M. J. Franz is a nutrition/health consultant with Nutrition Concepts by Franz, Inc, Minneapolis, MN.
K. Kulkarni is coordinator, Diabetes Center, St Mark’s Hospital, Salt Lake City, UT.
R. G. Schafer is a clinical dietitian, Diabetes Clinic, Bay Pines Veterans Affairs Medical Center, Bay Pines, FL.
E. Pritchett is a clinical dietitian, Mariners Hospital, Tavernier, FL; at the time the paper was written, she was with Quality Management, American Dietetic Association, Chicago, IL.
N. G. Clark is Vice President, Clinical Affairs, American Diabetes Association, Alexandria, VA.