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Teachable Moment
Less Is More
March 21, 2022

Inpatient Management of Type 2 Diabetes

Author Affiliations
  • 1Beth Israel Deaconess Medical Center, Boston, Massachusetts
  • 2Hospital Medicine, The Johns Hopkins Hospital, Baltimore, Maryland
JAMA Intern Med. 2022;182(5):543-544. doi:10.1001/jamainternmed.2022.0410

A middle-aged man with a history of decompensated cirrhosis with ascites and non–insulin-dependent type 2 diabetes with a hemoglobin A1c level of 6.9% (to convert to the proportion of total hemoglobin, multiply by 0.01) 2 months prior was admitted to the hospital for altered mental status and hyponatremia. On admission, his home metformin use was temporarily halted and sliding scale insulin (SSI) was ordered, with finger stick blood glucose (FSBG) checks at breakfast, lunch, dinner, and bedtime (QACHS). The patient’s mental status improved with treatment with lactulose, and he was eating full meals by hospital day 2. During these 2 days, he was found to have an FSBG level of greater than 180 mg/dL (to convert to mmol/L, multiply by 0.0555) only once. However, while the hyponatremia improved and the patient awaited acceptance to the rehabilitation department, his SSI order was maintained for an 8-day hospitalization, resulting in 30 FSBG checks that ranged from 100 mg/dL to 180 mg/dL without the need for treatment with insulin to maintain a target of 140 mg/dL to 180 mg/dL. Because many patients are treated without insulin, this raised the question: could we spare these patients from frequent FSBG checks?

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