Diabetesmanagement im Krankenhaus (Update 2019)

Abstract

This position statement presents the recommendations of the Austrian Diabetes Association for diabetes management of adult patients during inpatient stay. It is based on the current evidence with respect to blood glucose targets, insulin therapy and treatment with oral antidiabetic drugs during inpatient hospitalization. Additionally, special circumstances such as intravenous insulin therapy, concomitant therapy with glucocorticoids and use of diabetes technology during hospitalization are discussed.

Position statement: surgery and diabetes mellitus (Update 2023)

“…Die folgenden Empfehlungen beziehen sich auf Menschen mit Diabetes mellitus und die entsprechende Indikation der genannten Substanzklassen, nicht aber auf weitere Anwendungsbereiche außerhalb der antidiabetischen Wirkung (insbesondere GLP1-RA und SGLT-2-Inhibitoren). Zum Diabetesmanagement im Krankenhaus abseits von Operationen wird auf das entsprechende Leitlinienkapitel verwiesen [ 59 ].…”

“…Im Optimalfall ist präoperativ jedoch bereits eine Evaluierung und gegebenenfalls Anpassung der Basaldosis (z. B. Basalratentest, CGM-Verlauf über Nacht) erfolgt [ 7 , 59 , 74 , 138 , 141 ].…”

A Practical Guide for the Management of Steroid Induced Hyperglycaemia in the Hospital

“…Of note, the continuation of using preexisting insulin pump therapy (continuous subcutaneous insulin infusion [CSII]) in the hospital is not recommended in the majority of cases especially in those who are acutely hospitalized and severely ill. In patients without physical or mental disorders, the self-managed continuation of CSII therapy might be justified [ 63 , 64 ]. CSII systems provide adjustable basal rates, programming of different basal rate profiles as well as a temporary % increase/decrease of the current basal rate.…”

“…Intravenous insulin provides the advantage of more rapid insulin adjustments to hyperglycaemic levels. Rapid-acting human insulin or analogues should be prepared by 50 IU rapid-acting insulin mixed with 50 mL sodium chloride (0.9%) with a starting dose of 0.1 IU/kg/h [ 64 ]. The switch to subcutaneous insulin is recommended when patient status improves (e.g., uptake of oral nutrition, scheduled transfer to general ward) and metabolic status is balanced.…”

“…The switch to subcutaneous insulin is recommended when patient status improves (e.g., uptake of oral nutrition, scheduled transfer to general ward) and metabolic status is balanced. Basal insulin can be started at a dose of 50% of the previous 24 h insulin dose as administered intravenously in an overlapping manner (basal insulin application 2 h prior to cessation of intravenous insulin) in order to prevent rebound hyperglycaemia or acidosis [ 64 ]. Of course, also critically ill patients with SIHG should be treated with intravenous insulin, however, no specific recommendations for the treatment with intravenous insulin differing from the recommendation in “usual” critical care hyperglycaemia are available.…”