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• W3023996841 abstract "The COVID-19 pandemic has had a dramatic impact on the provision of acute inpatient care with specialists from all disciplines having to manage patients outside of their usual speciality areas. In many UK hospitals diabetes consultants and diabetes inpatient specialist nurses have been redeployed to the wards to care for COVID-19 positive or suspected cases. Consequently, clinicians relatively unfamiliar with managing hyperglycaemia have been required to do so as the usual input from diabetes specialist teams has not been possible in many areas. The National Diabetes Inpatient COVID-19 Response Group was formed to provide guidance to those involved in the care of inpatients with diabetes during this crisis. We have published in a previous issue of this journal guidance on care at the ‘front door’ aimed at emergency departments and admitting teams [1]. We now present guidance on the management of inpatient hyperglycaemia (Figure 1). We recognise that most hospitals will already have established local guidance in place. The current guidance is intended to help supplement and update existing guidance with a particular reference to supporting those less experienced in insulin use. In this respect, it is tailored to manage hyperglycaemia but as much as possible reducing the risk of overcorrection resulting in hypoglycaemia. It thus sets more liberal glycaemic targets than have been suggested in previous UK guidelines [2]. The COVID specific diabetes algorithms aim to achieve a ‘lower’ target of 6.0 mmol/L (higher than the previous of 4.0mmol/L) yet to keep blood glucose levels less than 10.0 mmol/L with up to 12.0 mmol/L being acceptable. Uniquely, it provides 3 different correction regimes for rapid acting analogue insulin based on the information available to the clinician. Firstly, if the person with diabetes knows their own ‘correction dose’ this should be used (e.g. for people with type 1 diabetes who are DAFNE trained, 1 unit reduces the blood glucose by 3.0 mmol/L). Secondly, if the total daily dose is known the correction is based on intervals of less than 50 units/day, 50-100 units/day and over 100 units/day. Finally, where none of the previous are known, the correction is based on weight with intervals of less than 50 kg, 50-100 kg and > 100 kg (for insulin naïve people or those newly presenting). The guidance recommends commencement of a basal insulin if hyperglycaemia persists after several correction doses of rapid acting insulin within a 24 hr period. The algorithm recommends a starting dose related to the person’s weight and specific issues such as age, fragility and renal function. There are then dosing regimens related to the particular basal insulin available in individual hospitals. There is also a dose adjustment regimen for the basal regimen based on the blood glucose levels immediately prior to the timing of the basal insulin. Finally, the guidance recognises that the insulin dose may need adjustment, particularly the basal insulin dose when there is a change in insulin sensitivity such as can occur with improving infection, reduction in corticosteroid treatment and in those recovering from COVID-19 related insulin resistance. Although, this guidance has been introduced for use during the present pandemic it is possible that this more judicious glucose target that has been previously advocated by some [3] and the early intervention with basal insulin may become the established guidance for the future." @default.
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• W3023996841 date "2020-06-08" @default.
• W3023996841 modified "2023-09-27" @default.
• W3023996841 title "New Guidance on Managing Inpatient Hyperglycaemia during the COVID‐19 Pandemic" @default.
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• W3023996841 doi "https://doi.org/10.1111/dme.14327" @default.
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