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14-09-2017 | Inpatient diabetes | Review | Article

Management of Type 1 Diabetes in the Hospital Setting

Journal: Current Diabetes Reports

Authors: Carlos E. Mendez, Guillermo E. Umpierrez

Abstract

Purpose of Review

The purpose of this article was to review recent guideline recommendations on glycemic target, glucose monitoring, and therapeutic strategies, while providing practical recommendations for the management of medical and surgical patients with type 1 diabetes (T1D) admitted to critical and non-critical care settings.

Recent Findings

Studies evaluating safety and efficacy of insulin pump therapy, continuous glucose monitoring, electronic glucose management systems, and closed loop systems for the inpatient management of hyperglycemia are described.

Summary

Due to the increased prevalence and life expectancy of patients with type 1 diabetes, a growing number of these patients require hospitalization every year. Inpatient diabetes management is complex and is best provided by a multidisciplinary diabetes team. In the absence of such resource, providers and health care staff must become familiar with the features of this condition to avoid complications such as severe hyperglycemia, ketoacidosis, hypoglycemia, or glycemic variability. We reviewed most recent guidelines and relevant literature in the topic to provide practical recommendations for the inpatient management of patients with T1D.

Chiang JL, Kirkman MS, Laffel LM, Peters AL. Type 1 diabetes sourcebook authors. Type 1 diabetes through the life span: A position statement of the American Diabetes Association. Diabetes Care. 2014;37(7):2034–54.CrossRefPubMed

American Diabetes Association. Statistics About Diabetes Overall Numbers, Diabetes and Prediabetes. Available at: http://www.diabetes.org/diabetes-basics/statistics/?referrer=https://www.google.com/?referrer=http://www.diabetes.org/diabetes-basics/statistics/. Accessed January 26, 2017.

Maahs DM, West NA, Lawrence JM, Mayer-Davis EJ. Epidemiology of type 1 diabetes. Endocrinol Metab Clin N Am. 2010;39(3):481–97.CrossRef

• Sayers A, Thayer D, Harvey JN, Luzio S, Atkinson MD, French R, et al. Evidence for a persistent, major excess in all cause admissions to hospital in children with type-1 diabetes: Results from a large welsh national matched community cohort study. BMJ Open. 2015;(4):5, e005644. This study shows the increased rates of hospitalizations in patients with T1D compared to general population

Patterson CC, Dahlquist GG, Gyurus E, Green A, Soltesz G, EURODIAB Study Group. Incidence trends for childhood type 1 diabetes in Europe during 1989-2003 and predicted new cases 2005-20: A multicentre prospective registration study. Lancet. 2009;373(9680):2027–33.CrossRefPubMed

Atkinson MA, Eisenbarth GS, Michels AW. Type 1 diabetes. Lancet. 2014;383(9911):69–82.CrossRefPubMed

Icks A, Rosenbauer J, Holl RW, Grabert M, Rathmann W, Giani G, et al. Hospitalization among diabetic children and adolescents and the general population in Germany. German working Group for Pediatric Diabetology. Diabetes Care. 2001;24(3):435–40.CrossRefPubMed

Tomlin AM, Tilyard MW, Dovey SM, Dawson AG. Hospital admissions in diabetic and non-diabetic patients: A case-control study. Diabetes Res Clin Pract. 2006;73(3):260–7.CrossRefPubMed

Donnan PT, Leese GP, Morris AD. Diabetes audit and research in Tayside, Scotland/medicine monitoring unit collaboration. Hospitalizations for people with type 1 and type 2 diabetes compared with the nondiabetic population of Tayside, Scotland: A retrospective cohort study of resource use. Diabetes Care. 2000;23(12):1774–9.CrossRefPubMed

10.

Angus VC, Waugh N. Hospital admission patterns subsequent to diagnosis of type 1 diabetes in children : A systematic review. BMC Health Serv Res. 2007;7:199.CrossRefPubMedPubMedCentral

11.

Robertshaw HJ, Hall GM. Diabetes mellitus: Anaesthetic management. Anaesthesia. 2006;61(12):1187–90.CrossRefPubMed

12.

Umpierrez GE, Kitabchi AE. Diabetic ketoacidosis: Risk factors and management strategies. Treat Endocrinol. 2003;2(2):95–108.CrossRefPubMed

13.

Cryer PE. Hypoglycemia in type 1 diabetes mellitus. Endocrinol Metab Clin N Am. 2010;39(3):641–54.CrossRef

14.

Mendez CE, Umpierrez G. Management of the hospitalized patient with type 1 diabetes mellitus. Hosp Pract (1995). 2013;41(3):89–100.CrossRef

15.

Umpierrez GE, Hellman R, Korytkowski MT, Kosiborod M, Maynard GA, Montori VM, et al. Management of hyperglycemia in hospitalized patients in non-critical care setting: An endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2012;97(1):16–38.CrossRefPubMed

16.

Krinsley JS, Egi M, Kiss A, Devendra AN, Schuetz P, Maurer PM, et al. Diabetic status and the relation of the three domains of glycemic control to mortality in critically ill patients: An international multicenter cohort study. Crit Care. 2013;17(2):R37.CrossRefPubMedPubMedCentral

17.

Viens NA, Hug KT, Marchant MH, Cook C, Vail TP, Bolognesi MP. Role of diabetes type in perioperative outcomes after hip and knee arthroplasty in the United States. J Surg Orthop Adv. 2012;21(4):253–60.CrossRefPubMed

18.

Clement S, Braithwaite SS, Magee MF, Ahmann A, Smith EP, Schafer RG, et al. Management of diabetes and hyperglycemia in hospitals. Diabetes Care. 2004;27(2):553–91.CrossRefPubMed

19.

American Diabetes Association. Standards of medical Care in Diabetes-2017 abridged for primary care providers. Clin Diabetes. 2017;35(1):5–26.CrossRef

20.

Simmons D, Hartnell S, Watts J, Ward C, Davenport K, Gunn E, et al. Effectiveness of a multidisciplinary team approach to the prevention of readmission for acute glycaemic events. Diabet Med. 2015;32(10):1361–7.CrossRefPubMed

21.

Cook CB, Castro JC, Schmidt RE, Gauthier SM, Whitaker MD, Roust LR, et al. Diabetes care in hospitalized noncritically ill patients: More evidence for clinical inertia and negative therapeutic momentum. J Hosp Med. 2007;2(4):203–11.CrossRefPubMed

22.

Cook CB, Kongable GL, Potter DJ, Abad VJ, Leija DE, Anderson M. Inpatient glucose control: A glycemic survey of 126 U.S. hospitals. J Hosp Med. 2009;4(9):E7–E14.CrossRefPubMed

23.

Heinemann L, Fleming GA, Petrie JR, Holl RW, Bergenstal RM, Peters AL. Insulin pump risks and benefits: A clinical appraisal of pump safety standards, adverse event reporting and research needs. A joint statement of the European Association for the Study of diabetes and the American Diabetes Association diabetes technology working group. Diabetologia. 2015;58(5):862–70.CrossRefPubMed

24.

Duggan EW, Carlson K, Umpierrez GE. Perioperative hyperglycemia management: An update. Anesthesiology. 2017;126(3):547–60.CrossRefPubMed

25.

Bailon RM, Partlow BJ, Miller-Cage V, Boyle ME, Castro JC, Bourgeois PB, et al. Continuous subcutaneous insulin infusion (insulin pump) therapy can be safely used in the hospital in select patients. Endocr Pract. 2009;15(1):24–9.CrossRefPubMed

26.

Cook CB, Boyle ME, Cisar NS, Miller-Cage V, Bourgeois P, Roust LR, et al. Use of continuous subcutaneous insulin infusion (insulin pump) therapy in the hospital setting: Proposed guidelines and outcome measures. Diabetes Educ. 2005;31(6):849–57.CrossRefPubMed

27.

Yogi-Morren D, Lansang MC. Management of patients with type 1 diabetes in the hospital. Curr Diab Rep. 2014;14(2):458.CrossRefPubMed

28.

Fayfman M, Pasquel FJ, Umpierrez GE. Management of Hyperglycemic Crises: Diabetic ketoacidosis and hyperglycemic hyperosmolar state. Med Clin North Am. 2017;101(3):587–606.CrossRefPubMed

29.

Umpierrez G, Korytkowski M. Diabetic emergencies - ketoacidosis, hyperglycaemic hyperosmolar state and hypoglycaemia. Nat Rev Endocrinol. 2016;12(4):222–32.CrossRefPubMed

30.

Moghissi ES, Korytkowski MT, DiNardo M, Einhorn D, Hellman R, Hirsch IB, et al. American Association of Clinical Endocrinologists and American Diabetes Association consensus statement on inpatient glycemic control. Diabetes Care. 2009;32(6):1119–31.CrossRefPubMedPubMedCentral

31.

Smiley D, Rhee M, Peng L, Roediger L, Mulligan P, Satterwhite L, et al. Safety and efficacy of continuous insulin infusion in noncritical care settings. J Hosp Med. 2010;5(4):212–7.CrossRefPubMedPubMedCentral

32.

Juneja R, Foster SA, Whiteman D, Fahrbach JL. The nuts and bolts of subcutaneous insulin therapy in non-critical care hospital settings. Postgrad Med. 2010;122(1):153–62.CrossRefPubMed

33.

Cryer PE, Axelrod L, Grossman AB, Heller SR, Montori VM, Seaquist ER, et al. Evaluation and management of adult hypoglycemic disorders: An Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2009;94(3):709–28.CrossRefPubMed

34.

Cobaugh DJ, Maynard G, Cooper L, Kienle PC, Vigersky R, Childers D, et al. Enhancing insulin-use safety in hospitals: Practical recommendations from an ASHP Foundation expert consensus panel. Am J Health Syst Pharm. 2013;70(16):1404–13.CrossRefPubMed

35.

American Diabetes Association. 14. Diabetes Care in the Hospital. Diabetes Care. 2017;40(Suppl 1):S120–7.CrossRef

36.

Kanji S, Buffie J, Hutton B, Bunting PS, Singh A, McDonald K, et al. Reliability of point-of-care testing for glucose measurement in critically ill adults. Crit Care Med. 2005;33(12):2778–85.CrossRefPubMed

37.

Dungan K, Chapman J, Braithwaite SS, Buse J. Glucose measurement: Confounding issues in setting targets for inpatient management. Diabetes Care. 2007;30(2):403–9.CrossRefPubMed

38.

Klonoff DC, Buckingham B, Christiansen JS, Montori VM, Tamborlane WV, Vigersky RA, et al. Continuous glucose monitoring: An Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2011;96(10):2968–79.CrossRefPubMed

39.

•• Wallia A, Umpierrez GE, Nasraway SA, Klonoff DC. PRIDE investigators. Round table discussion on inpatient use of continuous glucose monitoring at the international hospital diabetes meeting. J Diabetes Sci Technol. 2016;10(5):1174–81. This article summarizes the potential advantages and disadvantages of using CGM in the hospital setting CrossRefPubMedPubMedCentral

40.

Gottschalk A, Welp HA, Leser L, Lanckohr C, Wempe C, Ellger B. Continuous glucose monitoring in patients undergoing extracorporeal ventricular assist therapy. PLoS One. 2016;11(3):e0148778.CrossRefPubMedPubMedCentral

41.

Clarke WL, Kovatchev B. Continuous glucose sensors: Continuing questions about clinical accuracy. J Diabetes Sci Technol. 2007;1(5):669–75.CrossRefPubMedPubMedCentral

42.

Kosiborod M, Gottlieb RK, Sekella JA, Peterman D, Grodzinsky A, Kennedy P, et al. Performance of the Medtronic Sentrino continuous glucose management (CGM) system in the cardiac intensive care unit. BMJ Open Diabetes Res Care. 2014;2(1):e000037.CrossRefPubMedPubMedCentral

43.

Leelarathna L, English SW, Thabit H, Caldwell K, Allen JM, Kumareswaran K, et al. Accuracy of subcutaneous continuous glucose monitoring in critically ill adults: Improved sensor performance with enhanced calibrations. Diabetes Technol Ther. 2014;16(2):97–101.CrossRefPubMedPubMedCentral

44.

Boom DT, Sechterberger MK, Rijkenberg S, Kreder S, Bosman RJ, Wester JP, et al. Insulin treatment guided by subcutaneous continuous glucose monitoring compared to frequent point-of-care measurement in critically ill patients: A randomized controlled trial. Crit Care. 2014;18(4):453.CrossRefPubMedPubMedCentral

45.

Bridges BC, Preissig CM, Maher KO, Rigby MR. Continuous glucose monitors prove highly accurate in critically ill children. Crit Care. 2010;14(5):R176.CrossRefPubMedPubMedCentral

46.

Thomas F, Signal M, Harris DL, Weston PJ, Harding JE, Shaw GM, et al. Continuous glucose monitoring in newborn infants: How do errors in calibration measurements affect detected hypoglycemia? J Diabetes Sci Technol. 2014;8(3):543–50.CrossRefPubMedPubMedCentral

47.

Miller KM, Foster NC, Beck RW, Bergenstal RM, DuBose SN, DiMeglio LA, et al. Current state of type 1 diabetes treatment in the U.S.: Updated data from the T1D exchange clinic registry. Diabetes Care. 2015;38(6):971–8.CrossRefPubMed

48.

Murad MH, Coburn JA, Coto-Yglesias F, Dzyubak S, Hazem A, Lane MA, et al. Glycemic control in non-critically ill hospitalized patients: A systematic review and meta-analysis. J Clin Endocrinol Metab. 2012;97(1):49–58.CrossRefPubMed

49.

Whitham D. Nutrition management of diabetes in acute care. Can J Diabetes. 2014;38(2):90–3.CrossRefPubMed

50.

Gosmanov AR, Umpierrez GE. Medical nutrition therapy in hospitalized patients with diabetes. Curr Diab Rep. 2012;12(1):93–100.CrossRefPubMedPubMedCentral

51.

American Diabetes Association, Bantle JP, Wylie-Rosett J, Albright AL, Apovian CM, Clark NG, et al. Nutrition recommendations and interventions for diabetes: A position statement of the American Diabetes Association. Diabetes Care. 2008;31(Suppl 1):S61–78.CrossRef

52.

Malmberg K, Ryden L, Efendic S, Herlitz J, Nicol P, Waldenstrom A, et al. Randomized trial of insulin-glucose infusion followed by subcutaneous insulin treatment in diabetic patients with acute myocardial infarction (DIGAMI study): Effects on mortality at 1 year. J Am Coll Cardiol. 1995;26(1):57–65.CrossRefPubMed

53.

Garber AJ, Moghissi ES, Bransome ED Jr, Clark NG, Clement S, Cobin RH, et al. American College of Endocrinology position statement on inpatient diabetes and metabolic control. Endocr Pract. 2004;10(1):77–82.CrossRefPubMed

54.

Inzucchi SE. Clinical practice. Management of hyperglycemia in the hospital setting. N Engl J Med. 2006;355(18):1903–11.CrossRefPubMed

55.

Nau KC, Lorenzetti RC, Cucuzzella M, Devine T, Kline J. Glycemic control in hospitalized patients not in intensive care: Beyond sliding-scale insulin. Am Fam Physician. 2010;81(9):1130–5.PubMed

56.

Guthrie DW, Guthrie RA, Hinnen D, Childs BP. It's time to abandon the sliding scale. J Fam Pract. 2011;60(5):266–70.PubMed

57.

Page RL, Linnebur SA, Bryant LL, Ruscin JM. Inappropriate prescribing in the hospitalized elderly patient: Defining the problem, evaluation tools, and possible solutions. Clin Interv Aging. 2010;5:75–87.CrossRefPubMedPubMedCentral

58.

Hinzmann R, Schlaeger C, Tran CT. What do we need beyond hemoglobin A1c to get the complete picture of glycemia in people with diabetes? Int J Med Sci. 2012;9(8):665–81.CrossRefPubMedPubMedCentral

59.

Umpierrez GE, Hor T, Smiley D, Temponi A, Umpierrez D, Ceron M, et al. Comparison of inpatient insulin regimens with detemir plus aspart versus neutral protamine hagedorn plus regular in medical patients with type 2 diabetes. J Clin Endocrinol Metab. 2009;94(2):564–9.CrossRefPubMed

60.

• Bellido V, Suarez L, Rodriguez MG, Sanchez C, Dieguez M, Riestra M, et al. Comparison of basal-bolus and premixed insulin regimens in hospitalized patients with type 2 diabetes. Diabetes Care. 2015;38(12):2211–6. This study shows the importance of avoiding premixed insulin in the hospital setting CrossRefPubMedPubMedCentral

61.

Davidson PC, Hebblewhite HR, Steed RD, Bode BW. Analysis of guidelines for basal-bolus insulin dosing: Basal insulin, correction factor, and carbohydrate-to-insulin ratio. Endocr Pract. 2008 Dec;14(9):1095–101.CrossRefPubMed

62.

King AB, Armstrong DU. A prospective evaluation of insulin dosing recommendations in patients with type 1 diabetes at near normal glucose control: Bolus dosing. J Diabetes Sci Technol. 2007;1(1):42–6.CrossRefPubMedPubMedCentral

63.

Leonhardi BJ, Boyle ME, Beer KA, Seifert KM, Bailey M, Miller-Cage V, et al. Use of continuous subcutaneous insulin infusion (insulin pump) therapy in the hospital: A review of one institution's experience. J Diabetes Sci Technol. 2008;2(6):948–62.CrossRefPubMedPubMedCentral

64.

Nassar AA, Partlow BJ, Boyle ME, Castro JC, Bourgeois PB, Cook CB. Outpatient-to-inpatient transition of insulin pump therapy: Successes and continuing challenges. J Diabetes Sci Technol. 2010;4(4):863–72.CrossRefPubMedPubMedCentral

65.

Cook CB, Beer KA, Seifert KM, Boyle ME, Mackey PA, Castro JC. Transitioning insulin pump therapy from the outpatient to the inpatient setting: A review of 6 years' experience with 253 cases. J Diabetes Sci Technol. 2012;6(5):995–1002.CrossRefPubMedPubMedCentral

66.

Canadian Diabetes Association Clinical Practice Guidelines Expert Committee. Canadian Diabetes Association 2013 clinical practice guidelines for the prevention and Management of Diabetes in Canada. Can J Diabetes. 2013;37(suppl 1):S1–S212.

67.

Mabrey ME, Setji TL. Patient self-Management of Diabetes Care in the inpatient setting: Pro. J Diabetes Sci Technol. 2015;9(5):1152–4.CrossRefPubMedPubMedCentral

68.

Munt R, Hutton A. Type 1 diabetes mellitus (T1DM) self management in hospital; is it possible? A literature review. Contemp Nurse. 2012;40(2):179–93.CrossRefPubMed

69.

Jacobi J, Bircher N, Krinsley J, Agus M, Braithwaite SS, Deutschman C, et al. Guidelines for the use of an insulin infusion for the management of hyperglycemia in critically ill patients. Crit Care Med. 2012;40(12):3251–76.CrossRefPubMed

70.

Umpierrez GE, Isaacs SD, Bazargan N, You X, Thaler LM, Kitabchi AE. Hyperglycemia: An independent marker of in-hospital mortality in patients with undiagnosed diabetes. J Clin Endocrinol Metab. 2002;87(3):978–82.CrossRefPubMed

71.

Falciglia M, Freyberg RW, Almenoff PL, D'Alessio DA, Render ML. Hyperglycemia-related mortality in critically ill patients varies with admission diagnosis. Crit Care Med. 2009;37(12):3001–9.CrossRefPubMedPubMedCentral

72.

Furnary AP, Gao G, Grunkemeier GL, Wu Y, Zerr KJ, Bookin SO, et al. Continuous insulin infusion reduces mortality in patients with diabetes undergoing coronary artery bypass grafting. J Thorac Cardiovasc Surg. 2003;125(5):1007–21.CrossRefPubMed

73.

van den Berghe G, Wouters P, Weekers F, Verwaest C, Bruyninckx F, Schetz M, et al. Intensive insulin therapy in critically ill patients. N Engl J Med. 2001;345(19):1359–67.CrossRefPubMed

74.

Griesdale DE, de Souza RJ, van Dam RM, Heyland DK, Cook DJ, Malhotra A, et al. Intensive insulin therapy and mortality among critically ill patients: A meta-analysis including NICE-SUGAR study data. CMAJ. 2009;180(8):821–7.CrossRefPubMed

75.

Wilson M, Weinreb J, Hoo GW. Intensive insulin therapy in critical care: A review of 12 protocols. Diabetes Care. 2007;30(4):1005–11.CrossRefPubMed

76.

American Diabetes Association (ADA). Standards of Medical Care in Diabetes. Diabetes Care 2015; 38(S1-S2).

77.

Newton CA, Smiley D, Bode BW, Kitabchi AE, Davidson PC, Jacobs S, et al. A comparison study of continuous insulin infusion protocols in the medical intensive care unit: Computer-guided vs. standard column-based algorithms. J Hosp Med. 2010;5(8):432–7.CrossRefPubMedPubMedCentral

78.

Tanenberg RJ, Hardee S, Rothermel C, Drake AJ R. Use of a Computer-Guided Glucose Management System to Improve Glycemic Control and Address National Quality Measures: a 7-Year Retrospective Observational Study at a Tertiary Care Teaching Hospital. Endocr Pract 2016; 14.

79.

Kuntschen F, Galletti PM, Hahn C. Blood glucose control by closed loop insulin delivery during coronary artery bypass surgery. Trans Am Soc Artif Intern Organs. 1981;27:241–5.PubMed

80.

Watson BG, Elliott MJ, Pay DA, Williamson M. Diabetes mellitus and open heart surgery. A simple, practical closed-loop insulin infusion system for blood glucose control. Anaesthesia. 1986;41(3):250–7.CrossRefPubMed

81.

Yatabe T, Nakamura R, Kitagawa H, Munekage M, Hanazaki K. A case of perioperative glucose control by using an artificial pancreas in a patient with glycogen storage disease. J Artif Organs. 2016;19(1):100–3.CrossRefPubMed

82.

•• Namikawa T, Munekage M, Kitagawa H, Yatabe T, Maeda H, Tsukamoto Y, et al. Comparison between a novel and conventional artificial pancreas for perioperative glycemic control using a closed-loop system. J Artif Organs 2016 20. This study shows successful utilization of a closed loop artificial pancreas in the perioperative period

83.

Okabayashi T, Nishimori I, Yamashita K, Sugimoto T, Maeda H, Yatabe T, et al. Continuous postoperative blood glucose monitoring and control by artificial pancreas in patients having pancreatic resection: A prospective randomized clinical trial. Arch Surg. 2009;144(10):933–7.CrossRefPubMed

84.

Hanazaki K, Kitagawa H, Yatabe T, Munekage M, Dabanaka K, Takezaki Y, et al. Perioperative intensive insulin therapy using an artificial endocrine pancreas with closed-loop glycemic control system: The effects of no hypoglycemia. Am J Surg. 2014;207(6):935–41.CrossRefPubMed

85.

Maeda H, Okabayashi T, Yatabe T, Yamashita K, Hanazaki K. Perioperative intensive insulin therapy using artificial endocrine pancreas in patients undergoing pancreatectomy. World J Gastroenterol. 2009;15(33):4111–5.CrossRefPubMedPubMedCentral

86.

Yatabe T, Nishigaki A, Kitagawa H, Namikawa T, Hanazaki K, Yokoyama M. Successful treatment of hyperkalaemia with insulin therapy using a closed-loop glycaemic control device. Anaesth Intensive Care. 2016;44(2):294–5.PubMed

87.

Tsukamoto Y, Kinoshita Y, Kitagawa H, Munekage M, Munekage E, Takezaki Y, et al. Evaluation of a novel artificial pancreas: Closed loop glycemic control system with continuous blood glucose monitoring. Artif Organs. 2013;37(4):E67–73.CrossRefPubMed

88.

McDonnell ME, Umpierrez GE. Insulin therapy for the management of hyperglycemia in hospitalized patients. Endocrinol Metab Clin N Am. 2012;41(1):175–201.CrossRef

89.

Hsia E, Seggelke S, Gibbs J, Hawkins RM, Cohlmia E, Rasouli N, et al. Subcutaneous administration of glargine to diabetic patients receiving insulin infusion prevents rebound hyperglycemia. J Clin Endocrinol Metab. 2012;97(9):3132–7.CrossRefPubMed

90.

Mucha GT, Merkel S, Thomas W, Bantle JP. Fasting and insulin glargine in individuals with type 1 diabetes. Diabetes Care. 2004;27(5):1209–10.CrossRefPubMed

91.

Tridgell DM, Tridgell AH, Hirsch IB. Inpatient management of adults and children with type 1 diabetes. Endocrinol Metab Clin N Am. 2010;39(3):595–608.CrossRef

92.

Bevier WC, Zisser HC, Jovanovic L, Finan DA, Palerm CC, Seborg DE, et al. Use of continuous glucose monitoring to estimate insulin requirements in patients with type 1 diabetes mellitus during a short course of prednisone. J Diabetes Sci Technol. 2008;2(4):578–83.CrossRefPubMedPubMedCentral

93.

Gosmanov AR, Umpierrez GE. Management of hyperglycemia during enteral and parenteral nutrition therapy. Curr Diab Rep. 2013;13(1):155–62.CrossRefPubMedPubMedCentral

94.

Braithwaite SS. Inpatient insulin therapy. Curr Opin Endocrinol Diabetes Obes. 2008;15(2):159–66.CrossRefPubMed

95.

Via MA, Mechanick JI. Inpatient enteral and parenteral [corrected] nutrition for patients with diabetes. Curr Diab Rep. 2011;11(2):99–105.CrossRefPubMed

96.

Kreymann KG, Berger MM, Deutz NE, Hiesmayr M, Jolliet P, Kazandjiev G, et al. ESPEN guidelines on enteral nutrition: Intensive care. Clin Nutr. 2006;25(2):210–23.CrossRefPubMed

97.

Leon-Sanz M, Garcia-Luna PP, Sanz-Paris A, Gomez-Candela C, Casimiro C, Chamorro J, et al. Glycemic and lipid control in hospitalized type 2 diabetic patients: Evaluation of 2 enteral nutrition formulas low carbohydrate-high monounsaturated fat vs high carbohydrate. JPEN J Parenter Enteral Nutr. 2005;29(1):21–29.

98.

Craig LD, Nicholson S, SilVerstone FA, Kennedy RD. Use of a reduced-carbohydrate, modified-fat enteral formula for improving metabolic control and clinical outcomes in long-term care residents with type 2 diabetes: Results of a pilot trial. Nutrition. 1998;14(6):529–34.CrossRefPubMed

99.

Pasquel FJ, Spiegelman R, McCauley M, Smiley D, Umpierrez D, Johnson R, et al. Hyperglycemia during total parenteral nutrition: An important marker of poor outcome and mortality in hospitalized patients. Diabetes Care. 2010;33(4):739–41.CrossRefPubMed

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