Transition From Intravenous to Subcutaneous Insulin
Open Access
- 17 June 2011
- journal article
- Published by American Diabetes Association in Diabetes Care
- Vol. 34 (7), 1445-1450
- https://doi.org/10.2337/dc10-2023
Abstract
OBJECTIVE: The study objectives were 1) to assess the effectiveness and safety of a standardized protocol for the transition to subcutaneous insulin and oral feeding in diabetic or hyperglycemic patients with acute coronary syndrome (ACS) who were receiving intravenous insulin and glucose at the time of the transfer from the intensive cardiac care unit to a general ward and 2) to identify predictors of transition outcome. RESEARCH DESIGN AND METHODS: This was a prospective observational study. The protocol specifies that patients receive a 100% of their daily subcutaneous insulin requirement from the first day of oral feeding, calculated from the intravenous insulin rate during the final 12 h divided into two: 50% basal and 50% prandial. RESULTS: In 142 patients (93 male, 49 female, age range 47–88 years, 135 with known diabetes) the first day after transition, 44.8% of blood glucose (BG) measurements were within the strict range of 100–140 mg/dL before meals and 100–180 mg/dL after meals, and 70.8% were within the broader ranges of 80–160 mg/dL and 80–200 mg/dL, respectively. Pre- or postprandial hypoglycemia (BG <70 mg/dL) occurred in 11 patients (7.7%) on the first day and in 38 patients (26.8%) on the first 3 days after transition. Old age, high doses of intravenous insulin, and wide BG variations in the 24 h before insulin infusion was stopped were predictive of poor BG control after transition. CONCLUSIONS: This study shows the effectiveness and safety of a standardized protocol for the transition from intravenous to subcutaneous insulin in patients with ACS when regular oral feeding was resumed.This publication has 24 references indexed in Scilit:
- Standards of Medical Care in Diabetes—2010Diabetes Care, 2010
- American Association of Clinical Endocrinologists and American Diabetes Association Consensus Statement on Inpatient Glycemic ControlDiabetes Care, 2009
- Conversion from Continuous Insulin Infusions to Subcutaneous Insulin in Critically III PatientsAnnals of Pharmacotherapy, 2009
- Evaluation of glycemic control following discontinuation of an intensive insulin protocolJournal of Hospital Medicine, 2009
- Hyperglycemia and Acute Coronary SyndromeCirculation, 2008
- Management of Hyperglycemia in the Hospital SettingThe New England Journal of Medicine, 2006
- Conversion of Intravenous Insulin Infusions to Subcutaneously Administered Insulin Glargine in Patients With HyperglycemiaEndocrine Practice, 2006
- Inpatient Management of Hyperglycemia: The Northwestern ExperienceEndocrine Practice, 2006
- Effects of Outcome on In-Hospital Transition from Intravenous Insulin Infusion to Subcutaneous TherapyThe American Journal of Cardiology, 2006
- Guidelines on diabetes, pre-diabetes, and cardiovascular diseases: executive summary: The Task Force on Diabetes and Cardiovascular Diseases of the European Society of Cardiology (ESC) and of the European Association for the Study of Diabetes (EASD)European Heart Journal, 2006