Keterangan
Critically ill patients are at a higher risk of developing diabetes due to the stress on their body. Hypoglycemia, or low blood sugar, is a common complication of insulin therapy in critically ill patients with diabetes. Malnutrition, Infections can exacerbate diabetes in critically ill patients and lead to poor outcomes. Sepsis is a common complication which can lead to organ failure and increase mortality. Medications commonly used in critically ill patients, such as corticosteroids, can worsen glucose control in patients with diabetes. Critically ill patients with diabetes may require insulin pump therapy or continuous glucose monitoring (CGM) to manage their blood sugar levels effectively.
Ringkasan
- The webinar discusses managing diabetic patients in a critical care setting, focusing on patients admitted for reasons beyond diabetes but requiring glycemic control. It highlights the importance of addressing the primary critical illness before focusing solely on blood sugar management. The session uses a case scenario involving a patient with type 2 diabetes and subacute intestinal obstruction receiving total parenteral nutrition (TPN) to illustrate practical management challenges.
- The speaker addresses the common indications for hospitalizing diabetic patients, emphasizing that not every diabetic patient requires hospitalization. Specific conditions like newly diagnosed diabetes in children, acute metabolic complications (DKA, hypoglycemia), macro and microvascular complications, insulin pump initiation, and uncontrolled gestational diabetes warrant hospital admission.
- The target blood glucose level for critically ill patients is ideally less than 180 mg/dL initially. Once insulin therapy starts, it should range between 140-180 mg/dL. For non-critically ill or recovering patients, the target is less than 140 mg/dL pre-meal and less than 180 mg/dL post-meal.
- Several factors can hinder optimal glycemic control in hospitalized patients, including infections, steroid therapy, fever, surgical trauma, and immunosuppressive medications. These conditions can affect blood sugar levels and make it challenging to achieve the desired glycemic targets.
- Sliding scale insulin has limited use, particularly in septic shock, due to vasoconstrictors affecting subcutaneous absorption. It's more applicable for physiological adjustments of preprandial insulin or with basal insulin analogs. Sliding scales alone provide limited long-term glycemic control.
- Managing diabetes with TPN requires continuous insulin infusion, or regular insulin added to the TPN infusion based on the carbohydrate content. A reasonable starting point is 1 unit of insulin per 15 grams of carbohydrates, adjusting the ratio based on the patient's blood glucose levels. For enteral nutrition, continuous insulin infusion is initial treatment followed by NPH insulin added for intermittent feeding with small doses of regular insulin.
Contoh Sertifikat
Tentang Pembicara
Dr. Swati Panbude
Asisten Profesor, Biokimia, Datta Megha Institute of Medical Sciences, Wardha
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