Episode 93- An Expert Talks: Managing Hyperglycemia in the ER
This week, Dr. Michael Paddock answers some common insulin and diabetes management questions we have all had. Don’t miss out!
“An Expert Talks: Managing Hyperglycemia in the ER”:
– Different formulations of insulin have different pharmacokinetics:
– SQ long-acting basal insulins like glargine (Lantus) gradually take effect and last 20 + hours. SQ rapid-acting insulins like lispro and aspart (Humalog/ Novolog) peak at ~ 1 hour and last 6-8 hours. SQ regular insulin peaks in ~ 3 hours and lasts 8-10 hours. SQ intermediate insulin (NPH) peaks at ~ 4-6 hours and last 12-16 hours. SQ pre-mixed insulins (Humulin 70/30 and Humalog 75/25) contain mixtures of short and intermediate-acting insulins
– Only regular insulin is given IV, and typically in the ED setting should be reserved to shifting potassium in hyperkalemia or for treating DKA. SQ and IV regular insulin would ideally not be used to manage hyperglycemia (see kinetics above). For that, it’s best to use SQ rapid-acting insulin
– Most patients need 0.05-0.1 units/kg of SQ rapid-acting insulin when they are hyperglycemic. This can vary greatly if patients are known diabetics already taking insulin. If that’s the case, ask them what dose of insulin they would take at home with a given BG value, check previous notes/ fill histories for doses, or use your hospital’s inpatient hyperglycemia treatment panel to choose a reasonable dose
– We don’t have to meet a “goal” glucose level prior to discharging hyperglycemic patients from the ED. If anything, get their glucose down to a value less than what their glucometers can report (typically < 400-500). Being more aggressive than that is unnecessary; ensure the patient has adequate resources and follow-up