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Inpatient Hyperglycemia: Typical Versus Ideal Outpatient Follow-Up Care

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	PRESENTATION

 
M.G., a 54-year-old Hispanic woman, entered the Emergency Department with acute cholecystitis. Her chemistry profile revealed a random glucose of 325 mg/dl. She is 5 feet, 2 inches tall and weighs 186 lb. M.G. has had annual exams but was never told her blood glucose levels were high. Her parents both died from complications of type 2 diabetes. The Emergency Department staff initiated the hospital's routine diabetes orders. This included blood glucose measurements before meals and at bedtime, along with a supplemental scale of aspart insulin starting at 150 mg/dl. She was admitted for antibiotic therapy, but the surgeon preferred to perform her cholecystectomy as an outpatient procedure. The diabetes education team was consulted 3 days after the admission. Chart review revealed that M.G.'s blood glucose levels were still consistently > 150 mg/dl and that she received the sliding-scale insulin coverage but no routine basal or bolus doses. Insulin was not prescribed at discharge, and treatment was deferred to her primary care physician. Her hemoglobin A_1c (A1C) was 8.2%.

M.G. was taught blood glucose monitoring and normal levels, the basic pathophysiology of diabetes, and how to schedule an outpatient appointment. She was reminded of the importance of good blood glucose control before surgery.

M.G. returned 10 days later for an outpatient cholecystectomy. Her blood glucose was 190 mg/dl preoperatively and 236 mg/dl postoperatively. She was sent home with instructions to . . . [Full Text of this Article]

	QUESTIONS

 

	COMMENTARY

 

	Clinical Pearls

 

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