Cystic Fibrosis-Related Diabetes in Adults: Inpatient Management of 121 Patients during 410 Admissions

Abstract

Multiple hospitalizations and intensive inpatient management of CF are integral elements of treatment. Inpatient therapy for CFRD requires a customized approach that is uniquely different from that of type 1 or type 2 diabetes. Our experience highlights clinical circumstances such as irregular food intake, high dose steroid therapy, and supplemental tube feeding. For many patients, it is possible to continue CSII therapy during hospitalization through a combination of mutual trust between the patient and hospital staff and oversight provided by the glucose management team.

Practical Approach to Management of Inpatient Hyperglycemia in Select Patient Populations

“…When NPH insulin is administered concurrently with methylprednisolone or prednisone, it may be especially effective for inhibiting the hyperglycemia associated with once-daily glucocorticoids. 6,7 The NPH insulin may be added to the patient's existing glucose-lowering regimen and discontinued as soon as the glucocorticoid is discontinued. This method of dosing allows the effect of the NPH insulin dose to wear off as the hyperglycemic effect of the glucocorticoid dissipates, and minimizes the risk of hypoglycemia for the patient.…”

“…7 Unfortunately, little has been published regarding management of hyperglycemia in patients receiving multiple daily doses of glucocorticoids. Alternatives to using NPH insulin in this situation include using a single daily dose of basal insulin or increasing basal and bolus insulin doses by 30% to 50% across the board.…”

“…6,7 We have recently described our approach to selecting the initial dose of NPH insulin in hospitalized patients with cystic fibrosis-related diabetes who are started on glucocorticoid therapy. 7 The treatment course involves using 0.25 U of NPH insulin for every 1 mg of methylprednisolone administered once daily.…”

“…6,7 We have recently described our approach to selecting the initial dose of NPH insulin in hospitalized patients with cystic fibrosis-related diabetes who are started on glucocorticoid therapy. 7 The treatment course involves using 0.25 U of NPH insulin for every 1 mg of methylprednisolone administered once daily. However, for patients who are much more insulin resistant, we use 1 U of NPH insulin for every 1 mg of methylprednisolone for the first 20 mg of glucocorticoid; 0.5 U of NPH insulin for every 1 mg of methylprednisolone for the next 20 mg of glucocorticoid; and 0.25 U of NPH insulin for every 1 mg of methylprednisolone for each subsequent milligram of the administered steroid.…”

Insulin Use in Hospitalized Patients With Diabetes: Navigate With Care

“…18,19 NPH insulin can then be discontinued as soon as the glucocorticoid is discontinued, providing a safer option than having residual insulin action from high doses of long-acting insulin lasting for hours after discontinuation of steroids. The NPH insulin may be added to patients' existing insulin regimen and administered only as long as the patient is on glucocorticoids.…”