1. Diabetic Management
By effectively treating the diabetic patient while he/she
is in the hospital we can impact their care at home
Optimal diabetic management during hospitalization
speeds recovery and reduces costs
Common Mistakes
 Holding insulin inappropriately
 Over supplementation of hypoglycemia
 Inappropriate timing of blood glucose
testing, meds, and meals
 Accepting hyperglycemia without intervention
 Failing to educate patients and families

2. Diabetic Management (cont)
Insulin should never be held if the patient is eating and the blood
sugar is within normal range
Particularly with basal insulin (Lantus/Levemir), the nurse is
depriving the patient of an entire day of blood glucose coverage
While NPO patients should still receive basal insulin
(Lantus/Levemir), rapid-acting meal time doses (Novolog or
Regular) should be held in the absence of meal consumption.
Basal insulin is designed to mimic the body’s natural metabolism
and actually reduce the risk of hypoglycemia compared to other
insulin forms

3. Diabetic Management (cont)
Supplementation is not necessary until blood glucose dips
below 70
The standard of care should reflect the Rule of 15
• 15 grams/15 minutes
• For blood glucoses 50-69
• Provide 15 grams of rapid absorbing carbohydrates
• 4 oz juice or 4 oz of regular - not diet – soda or 8 oz of fat free
milk
• Recheck in 15 minutes
• Repeat until blood glucose reaches 70 mg/dl

4. Diabetic Management (cont)
For blood glucoses 49 and below
• Give 30 grams of rapid absorbing carbohydrates
• 8 oz juice or 8 oz of regular - not diet – soda
• Recheck in 15 minutes
• These amounts are ideal for helping the patient return to normal
blood glucose without inducing hyperglycemia
• If the next meal is more than one hour away, this initial
supplementation should be followed with a snack of mixed
nutrients such as milk & cereal, or PB and crackers

5. Diabetic Management (cont)
 Blood glucose testing occurs 30 minutes prior to meal delivery
 While the timing may vary from unit to unit based on times that
trays are received, it is important for staff to be aware of the time
trays are delivered in their area and plan interventions accordingly
 In like manner, rapid-acting insulin doses should be administered
within 15 minutes of the time the patient begins eating
 Basal insulin should be given at a consistent time, not necessarily
with meals

6. Diabetic Management (cont)
Accepting hyperglycemia
• Due to fear of hypoglycemia, both nurses and patients often
accept high blood glucoses rationalizing that “a little sweet is
better than low”
• While some apprehension is understandable, acknowledging
the target range (70-130) and reinforcing this goal with patients
will help deflate this false sense of security
• Proper diet control and a consistent treatment plan are the real
keys to success

7. Diabetic Management (cont)
Education
• A key piece of nursing is empowering our patients with knowledge
that will help them improve their overall wellness
• Our diabetes educator, as well as dieticians and pharmacy staff,
serve as excellent resources and may help to relieve the concerns
patients may experience while hospitalized
• Also, the individual nurse is in a powerful position of influence as
we walk our patients through the diabetic decisions they make
daily