The Hands-on Guide to Diabetes Care in Hospital is an ideal companion for ward practitioners, providing answers to these and many other practical diabetes problems, helping you to deliver safe and effective care to patients.

Table of Contents

• Preface
• Abbreviations
• PART 1 Basics
• 1 Classification of diabetes
• Phenotypic features of classical Type 1 and Type 2 diabetes
• 2 Targets for glycaemic control in hospital
• Myocardial infarction (Chapters 13 and 14)
• Stroke
• ICU/HDU
• Surgical patients (Chapter 27)
• References
• 3 Diagnosis of diabetes in hospitalised patients
• Stress hyperglycaemia
• 4 Nomenclature
• Capillary blood glucose
• VRIII (Variable Rate Intravenous Insulin Infusion, ‘sliding scale’ in the UK)
• HbA1c (glycated haemoglobin)
• References
• 5 Outline of physiology
• Insulin actions
• Diabetic ketoacidosis (Chapter 9)
• Insulin resistance
• Renal disease
• Hyperosmolar hyperglycaemic state
• Hypoglycaemia (Chapters 11 and 26)
• Further reading
• 6 Diabetes specialist nurses: roles and responsibilities
• PART 2 Acute diabetes problems
• 7 History taking in patients with diabetes
• Type of diabetes/diagnosis (Chapter 1)
• Duration of diabetes
• Treatment (Chapter 24)
• Complications
• 8 Assessment and initial management of patients presenting with high blood glucose levels to an emergency department
• Type 1 diabetes intercepted early In its course
• Poorly controlled patients with known Type 1 diabetes
• Newly presenting Type 2 diabetes
• Patients attending the ED with high blood glucose levels
• 9 Diabetic ketoacidosis
• Give soluble insulin intravenously at 6 U/hr
• Confirm the diagnosis
• Indicators of severity (Table 9.2)
• Overall management priorities
• ASK THE FOLLOWING after diagnosis, initial assessment and immediate treatment
• Acute management — up to 4 hours
• Management from 4–12 hours
• Check electrolytes at 8 hours
• Management from 12–24 hours
• Planning for discharge
• Further reading
• 10 Hyperosmolar hyperglycaemic state (HHS)
• Confirm the diagnosis (Table 10.1)
• Indicators of severity (Table 10.2)
• Management priorities (Table 10.3)
• Correcting serum [Na+] for prevailing glucose
• ask THE FOLLOWING after diagnosis, initial assessment and treatment
• Complete any ‘routine’ investigations
• Additional history
• Prescriptions
• Continuing management up to 24–48 hours
• Continuing management — usually after 24 hours
• 11 Managing acute hypoglycaemia in the emergency department
• Treatment (see Chapter 26)
• PART 3 Acute medical and surgical problems commonly complicated by diabetes
• 12 Presentation of cardiac disease in diabetic patients
• Features of ACS (Box 12.1)
• Heart failure
• 13 Acute coronary syndromes and stroke
• ACS
• Practicalities of blood glucose control in ACS patients (Figure 13.1)
• Stroke
• 14 Secondary prevention after ACS
• Table of checklist items (Table 14.1)
• 15 Acute pancreatitis
• Hyperglycaemia during and after AP
• Abdominal pain and hyperglycaemia
• Management of diabetes
• 16 Infections in diabetes
• Soft tissue infections
• TREATMENT (Table 16.1)
• Necrotizing fasciitis
• Diabetic foot ulcers
• Admission
• Osteomyelitis (Table 16.2)
• Charcot neuroarthropathy (Figure 16.7)
• Tissue viability team
• The Multidisciplinary foot team
• Urinary tract infections
• Choice of antibiotic
• Abdominal infections
• Musculoskeletal infections
• Chest infections
• Uncommon/rare infections thought to be almost specific to diabetes
• Postoperative infections
• PART 4 Insulin and non-insulin agents
• 17 Variable Rate Intravenous Insulin Infusion (VRIII, ‘sliding scale’ – UK; insulin drip – USA)
• Indications for VRIII (Table 17.1)
• 18 Converting from VRIII to subcutaneous insulin
• 19 Writing safe insulin prescriptions
• 20 Insulin preparations in the UK (BNF section 6.1.1)
• Background information
• NOTES ON Individual insulin preparations
• 21 Commonly used insulin regimens
• Basal insulin (Group 1; Figure 21.1)
• Basal-bolus regimen (Group 1 + Group 2; Figure 21.2)
• Biphasic (fixed-mixture) insulin regimens – Usually Two Times Daily Before Breakfast and Evening Meal, Sometimes Three Times Daily (Group 3; Figure 21.3)
• Insulin pump (Continuous Subcutaneous Insulin Infusion, CSII; Figure 21.4)
• 22 Emergency subcutaneous insulin regimens
• Scenario 1: New basal-bolus insulin (Multiple Dose Insulin, Three Injections of Fast-acting Preprandial Insulin, One Dose of Long-acting Insulin at Bedtime)
• Scenario 2: new twice-daily biphasic insulin (Type 2 patients)
• 23 Substituting insulin preparations in the emergency setting
• Discussion with patients
• Substitution
• 24 Non-insulin agents (BNF sections 6.1.2.1-3)
• Metformin
• Sulphonylureas (SU)
• Other classes of medication
• References
• PART 5 Blood glucose management on the wards
• 25 Managing patients you are asked to see with high blood glucose levels
• The patient with CBG >20 mmol/L (see Table 25.1)
• VRIII and ‘stat’ doses of soluble insulin
• References
• 26 Management of acute hypoglycaemia on the ward
• Mild/asymptomatic/biochemical hypoglycaemia (CBG <4.0 mmol/L)
• Oral treatment (Figure 26.1)
• Severe hypoglycaemia (BG <3.1 mmol/L)
• Parenteral treatment (Figure 26.2)
• Non-diabetic hypoglycaemia
• Further reading
• 27 Perioperative management of elective surgery
• Patients suitable for day-case surgery
• Poorly-controlled patients
• Admission the night before surgery
• Management of diabetes medication
• Intravenous fluids
• Further reading
• 28 Enteral feeding
• Non-insulin agents, including oral hypoglycaemics (Chapter 24)
• Insulin treatment (Box 28.1)
• Subcutaneous insulin
• Reference
• Further reading
• 29 Steroid-induced diabetes
• Management
• Further reading
• 30 Safe discharge of patients from hospital
• Discharge summary
• Sick day rules
• Medication
• Follow-up
• Guidelines and flowchart for patients
• PART 6 Important odds and ends
• 31 Technology in diabetes
• Capillary blood glucose metERs
• Urinalysis
• Insulin delivery devices
• Insulin pumps (Continuous Subcutaneous Insulin Infusion, CSII; Chapter 21)
• Existing and future technology which you may be asked about
• 32 Inpatient screening schedule
• Focused clinical examination (Figure 32.1)
• 33 Practical procedures
• Capillary blood glucose testing using a hospital-based system (Figure 33.1)
• Capillary blood glucose testing using a typical home device (Figure 33.2)
• Giving a subcutaneous insulin injection (Figure 33.3)
• Practical wound dressing for a diabetic foot ulcer (Figure 33.4)
• Direct ophthalmoscopy (Figure 33.5)
• 34 On-call guide to hyperglycaemic emergencies
• Hyperosmolar Hyperglycaemic State (HHS) – no longer called HONK
• Diabetic ketoacidosis (DKA)