Ellen D. Davis

Implementation of a new intravenous insulin method on intermediate-care units in hospitalized patients.

Good blood glucose control in hospitalized adults leads to reduced mortality. Intravenous (IV) insulin has been shown to be an effective way to achieve tight control of blood glucose. Managing IV insulin is a labor-intensive task for nurses and is generally done in intensive care units with high nurse-to-patient ratios. In this 3-month study, intermediate-care general medicine units with a nurse-to-patient ratio of 1 to 5 or 6 were evaluated for effectiveness of monitoring IV insulin. The project, which relied on intensive in-service education, an audit tool, and continuous positive feedback for nurses, yielded positive results.

Hyperglycemic-inducing neoadjuvant agents used in treatment of solid tumors: A review of the literature

PURPOSE/OBJECTIVES To review the literature regarding the development of hyperglycemia associated with neoadjuvant agents used in the treatment of solid tumor cancers. DATA SOURCES Research articles were obtained from PubMed, CINAHL®, and Cochrane Reviews. The following search terms were used alone and in combination: diabetes, glycemic control, chemotherapy, androgen deprivation therapy, interferon-alpha, immunosuppressants, cancer, neoplasms, and hyperglycemia. DATA SYNTHESIS Twenty-two studies were identified reporting the development of hyperglycemic events in patients who received a variety of chemotherapeutic agents. CONCLUSIONS Findings suggest patients are at risk for the development of hyperglycemia from certain chemotherapeutic agents. Docetaxel, everolimus, and temsirolimus alone or in combination with other agents can promote hyperglycemia. Androgen-deprivation therapy commonly used in prostate cancer, increases the risk for the development of hyperglycemia and diabetes. IMPLICATIONS FOR NURSING Oncology nurses play an important role in the identification and treatment of hyperglycemia in patients receiving chemotherapy. Future research is needed that focuses on the association between glycemic control and adverse outcomes in patients with a solid tumor cancer who are at risk for treatment-induced hyperglycemia.

Managing hyperglycemia and diabetes in patients receiving enteral feedings: A health system approach

Abstract Evidence of poor outcomes in hospitalized patients with hyperglycemia has led to new and revised guidelines for inpatient management of diabetes. As providers become more aware of the need for better blood glucose control, they are finding limited guidance in the management of patients receiving enteral nutrition. To address the lack of guidelines in this population, Duke University Health System has developed a consistent practice for managing such patients. Here, we present our practice strategies for insulin use in patients receiving enteral nutrition. Essential factors include assessing the patients’ history of diabetes, hyperglycemia, or hypoglycemia and timing and type of feedings. Insulin practices are then designed to address these issues keeping in mind patient safety in the event of abrupt cessation of nutrition. The outcome of the process is a consistent and safe method for glucose control with enteral nutrition.

Controlling Malglycemia in Patients Undergoing Treatment for Cancer

Patients with or without preexisting diabetes undergoing treatment for cancer may be at risk for malglycemic events. Malglycemia, particularly hyperglycemia and diabetes in patients with cancer, may lead to adverse outcomes. Prevention, prompt recognition, and early intervention to regulate malglycemia can optimize the effects of cancer treatment, minimize the harmful consequences, and improve quality of life for patients with cancer. The development of evidence-based standards of care and protocols are needed to guide clinical practice when caring for patients with cancer.

Transitioning to Outpatient Care

Orchestrating a smooth transition to outpatient care is critical for all patients with hyperglycemia in the inpatient setting. There are many factors to consider in preparing patients for discharge.

Inpatient Diabetes Education: Realistic and Evidence-Based

Hospitalization can present an opportunity to address unique urgent learning needs. Although some would argue that the hospital is a poor setting for patient education, this does not have to be the case. Brief targeted diabetes education is readily available, and take-home materials can reinforce instruction. Given the sheer volume of inpatients with diabetes, dedicated resources for their care and education are essential.