Protocol for Diabetes Management in hospital – 2014

Name ……………………………….. Hospital No……………….

Age/ Sex …………………Ht/Wt ……………………..

1. Diabetes

1) Known diabetes (Type 1 / Type 2 / Others) duration …………

2) Diabetes – New diagnosis ……………….

3) HbA1C ……………

2. Existing treatment of Diabetes mellitus

Name	Dose

 

Primary Consultant
Speciality Nurse –
Speciality Consultant

Ward Nurse-in-charge please inform the Duty Doctor in case blood sugar reading is out of range

                                                                        DIABETES MANAGEMENT

1. IV Insulin –

50 units of short acting insulin (…………………………) in 50ml NS

GLUCOMETER SUGAR (mg%)	INSULIN (ml/hr)
<100	Please inform
101 -120	nil
121-140	0.5 ml/hr*
141-160	1.0 ml/hr*
161-200	1.5 ml/hr*
201-240	3ml/hr*
>240	Please inform

• If three consecutive readings are in the same level, please inform.

B. GIK regimen –                                                                                                                                                                                            

                                                                                                                                                                                                                                        Date …………………………….

BASAL –

               Daytime (8 am till 10 pm) – DNS + KCl …….ml+ Insulin…………….…

               Nighttime (10 pm till 8 am) – DNS + KCl…….ml + Insulin ………………

CORRECTIVE – 4 hourly sc Insulin (…………..……………..)

GLUCOMETER SUGAR (mg%)	Insulin SC
< 100	Please inform
100-120
121 -140
141-160
161-200
201-240
>240	Please inform

Ward Nurse-in-charge please inform the Duty Doctor in case blood sugar reading is out of range

                                                                                                                                                                                                                                       Date ……………………………..

BASAL –

             Daytime (8 am till 10 pm) – DNS + KCl………ml+ Insulin…………………..

             Night time (10 pm till 8 am) – DNS + KCl………ml + Insulin ………………

CORRECTIVE – 4 hourly sc Insulin (…………..……………..)

GLUCOMETER SUGAR (mg%)	Insulin SC
< 100	Please inform
100-120
121 -140
141-160
161-200
201-240
>240	Please inform

                                                                                                                                                                                                                                       Date ……………………………..
BASAL –

Daytime (8 am till 10 pm) – DNS + KCl………ml+ Insulin……………………

Nighttime (10 pm till 8 am) – DNS + KCl…….ml + Insulin ……………..…

CORRECTIVE – 4 hourly sc Insulin (…………..……………..)

GLUCOMETER SUGAR (mg%)	Insulin SC
< 100	Please inform
100-120
121 -140
141-160
161-200
201-240
>240	Please inform

3. SC Insulin (Multiple SC Insulin injection Regimen)

                                        Date – ………………………

 

Ward Nurse-in-charge please inform the Duty Doctor in case blood sugar reading is out of range

 

 TARGET – Premeal 100-140, Postmeal 140-180 mg

	Time	GRBS	Insulin	Dose
				Advised	Modified to	Modified by
	Fasting
	2hrs after bf
	Bef lunch
	2hrs after lunch
	Bef dinner
	Bedtime
	Other time

                Date – ………………………

 TARGET – Premeal 100-140, Postmeal 140-180 mg

	Time	GRBS	Insulin	Dose
				Advised	Modified to	Modified by
	Fasting
	2hrs after bf
	Bef lunch
	2hrs after lunch
	Bef dinner
	Bedtime
	Other time

                                 Date – ………………………

   TARGET – Premeal 100-140, Postmeal 140-180 mg

	Time	GRBS	Insulin	Dose
				Advised	Modified to	Modified by
	Fasting
	2hrs after bf
	Bef lunch
	2hrs after lunch
	Bef dinner
	Bedtime
	Other time

                           Date – ………………………

 TARGET – Premeal 100-140, Postmeal 140-180 mg

	Time	GRBS	Insulin	Dose
				Advised	Modified to	Modified by
	Fasting
	2hrs after bf
	Bef lunch
	2hrs after lunch
	Bef dinner
	Bedtime
	Other time

Ward Nurse-in-charge please inform the Duty Doctor in case blood sugar reading is out of range

 

                    Date – ………………………

TARGET – Premeal 100-140, Postmeal 140-180 mg

	Time	GRBS	Insulin	Dose
				Advised	Modified to	Modified by
	Fasting
	2hrs after bf
	Bef lunch
	2hrs after lunch
	Bef dinner
	Bedtime
	Other time

Data collection

(Final Diagnosis …………………………………………………..)

1) Discharged / Died

2) Duration of Hospital stay …………….

3) Discharge medication for diabetes

a) tablet …………………………….

b) insulin …………………………….

4) Diabetes control in hospital

A. On IV Insulin – Good/Suboptimal/Poor

Duration ……….., Hypoglycaemia ……, Grade …….

B. On GIK regimen – Good/Suboptimal/Poor

Duration …………, Hypoglycaemia ……, Grade ……

5) Complication related to diabetes on SC Insulin

Ward Nurse-in-charge please inform the Duty Doctor in case blood sugar reading is out of range

a) DKA/HONK – ……….

b) Hypoglycaemia i) no. of episodes

                   ii) Grade of hypoglycaemia 1 / 2 / 3*

                   iii) Corrected per oral or i.v

6) Any other information – ……………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………