Insulin requirements in non-critically ill hospitalized patients with diabetes and steroid-induced hyperglycemia.

Elias K. Spanakis, Nina Shah, Keya Malhotra, Terri Kemmerer, Hsin Chieh Yeh, Sherita Hill Golden

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Abstract

Steroid-induced hyperglycemia is common in hospitalized patients with diabetes mellitus. Guidelines for glucose management in this setting are lacking. We conducted a retrospective chart review of non-critically ill patients with diabetes receiving steroids, hospitalized from January 2009 to October 2012. Fifty-eight patients were identified from 247 consults. Multivariable linear regression was used to assess median daily insulin requirements of normoglycemic patients compared with hyperglycemic patients. Of the 58 total patients included in our study, 20 achieved normoglycemia during admission (patient-day weighted mean blood glucose [PDWMBG] level = 154 ± 16 mg/dL) and 38 remained hyperglycemic (PDWMBG level = 243 ± 39 mg/dL; P <0.001). There were no differences between the 2 patient groups in age, sex, race, body weight, renal function, HbA1c level, glucose-altering medications, diabetes type, or disease duration. Following multivariable adjustment, compared with hyperglycemic patients, normoglycemic patients required similar units of basal insulin (median interquartile range [IQR])(23.6 [17.9, 31.2] vs 20.1 [16.5, 24.4]; P = 0.35); higher units of nutritional insulin (45.5 [34.2, 60.4] vs 20.1 [16.4, 24.5]; P <0.001]; and lower units of correctional insulin (5.8 [4.1, 8.1] vs 13.0 [10.2, 16.5]; P <0.001]). Patients achieving normoglycemia required a significantly lower percentage of correction insulin (total daily dose [TDD]: 7.4% vs 23.4%; P <0.001) and a higher percentage of nutritional insulin (TDD: 58.1% vs 36.2%; P

Original languageEnglish (US)
Pages (from-to)23-30
Number of pages8
JournalHospital practice (1995)
Volume42
Issue number2
StatePublished - 2014
Externally publishedYes

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Hyperglycemia
Steroids
Insulin
Blood Glucose
Glucose
Patient Admission
Linear Models
Diabetes Mellitus
Age Groups
Body Weight
Guidelines
Kidney

ASJC Scopus subject areas

  • Medicine(all)

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Insulin requirements in non-critically ill hospitalized patients with diabetes and steroid-induced hyperglycemia. / Spanakis, Elias K.; Shah, Nina; Malhotra, Keya; Kemmerer, Terri; Yeh, Hsin Chieh; Golden, Sherita Hill.

In: Hospital practice (1995), Vol. 42, No. 2, 2014, p. 23-30.

Research output: Contribution to journalArticle

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