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1. Differentiate glycemic targets for the hospitalized patient
2. Distinguish symptoms of hypo/hyperglycemia
3. Assess metabolic consequences of acute hyperglycemia
4. Utilize a standardized approach to managing glucose in patients on steroids, tube feedings and TPN
5. Calculate basal/ bolus (prandial) insulin dosing to achieve optimal glucose control
6. Formulate 2 ways the bedside nurse can reduce the incidence of hypoglycemia in the hospital
7. Analyze the use of oral agents in the hospital setting
8. Assess safety issues with using insulin pumps in the acute care setting
9. Design 2 system improvements that positively impact patient outcomes

Glycemic Targets for Hospitalized Patients

• Clear interpretation of AACE & ADA guidelines
• Adjusting limits for the critically ill patient
• Non-critical patients: How high is too high

Recognizing Symptoms of Hypoglycemia

• Hypoglycemic unawareness: How are we missing this?
• Interventions that change outcomes
• 15/15 Rule
• Timing and Dose: The good, the bad, the ugly
  • IV dextrose
  • Glucagon

Reducing Incidence of Hypoglycemia

• Finger sticks & technique - it does matter!
• Critical timing for pre-meal & correction insulin
• The nurse's role in ensuring carbohydrate-consistent meals

Symptoms & Critical Interventions for Hyperglycemia

• The differences of DKA & HHNK
• Diabetic Ketoacidosis
  • A complex metabolic process
  • Identifying the patient at risk
  • Managing fluid replacement to avoid complications
  • Insulin drips
  • Critical labs & acute management
• Nursing Management of HHNK
  • Identifying the symptoms
  • Don't forget your ABCs
  • Common laboratory pitfalls
  • Restoring electrolyte balance

Consequences of Acute Hyperglycemia

• Addressing & managing new wound infections
• The dangers of:
  • Platelet abnormalities
  • Inflammatory cytokine response
• The patient & the facility at risk:
  • Poor patient outcomes
  • Readmissions
  • Increased length of stay
• Insulin resistance

Treating Special Populations Using a Simple Formula

• The patient newly prescribed steroids
• Adjusting for tube feedings
• TPN: Understanding the effects for the diabetic patient
• Considerations for patients on R-U-500 insulin

Insulin for Improved Glucose Control

• Type 1 vs. Type 2 guidelines
• Action times of insulins
• Calculating Basal/ Bolus Insulin
• Miami 4/12 Rule
• Correction scales based on insulin sensitivity

Oral Agents in the Hospital Setting

• NPO vs eating status
• Precautions for Metformin

Safety Issues with Managing Insulin Pumps

• Patient exclusion criteria
• Recognizing pump problems
• When to remove pumps

System Improvements Positively Impacting Patient Outcomes

• Standardized correction scales based on insulin sensitivity
• Standard protocols for treating hypoglycemia
• Physician order sets for insulin initiation
• Carbohydrate labels on meal trays/snacks

Putting It All Together

• Case Studies: What went right and what went wrong
• Solving problems using the glucose accordion flowsheet report

Nancy Moline, RN, MEd, CDE, has more than 25 years of experience in diabetes management. As a diabetes nurse consultant, she recognized the need for hospital nurses to increase their knowledge and confidence in managing issues related to insulin and glucose control. Nancy designed a program for bedside nurses that resulted in decreased incidences of hypoglycemia and insulin errors. Additionally, she designed and coordinated the implementation of a diabetes chronic conditions management program for a large HMO, training nurses to become diabetes care managers.

Nancy is a published author whose work includes the article "Diabetes Management in a Health Maintenance Organization: Efficacy of Care Management using group Cluster visits" in the Diabetes Care Journal. She is also a past winner of the research award from Kaiser Permanente, Northern California for the Diabetes Cooperative Care Clinic. Nancy presents on the national level and is a regular presenter for the UCSF program "Becoming a Diabetes Educator."

Speaker Disclosures:

Financial: Nancy Moline has an employment relationship with Alta Bates Hospital. She receives an honorarium from Alameda County Health System; King Hooper Diabetes Education, Inc.; and University of California San Francisco Board of Nursing. Ms. Moline receives a speaking honorarium from PESI, Inc. She has no relevant financial relationships with ineligible organizations.

Nonfinancial: Nancy Moline is a member of the American Association of Diabetes Educators.

Save time and $10 off the price of other submission methods – purchase & take the CE test online for $9.99 USD per participant. Additional processing fees apply for other submission methods (i.e. mail, fax, etc.). Please contact our Customer Service at 1-800-844-8260 for more details.

Listed below are the continuing education credit(s) currently available for this non-interactive self-study package. Please note, your state licensing board dictates whether self study is an acceptable form of continuing education. Please refer to your state rules and regulations.

Certificates of Successful Completion are available for email, download and/or printing from your online account immediately following the successful completion of the post-test/evaluation.

**Materials that are included in this course may include interventions and modalities that are beyond the authorized practice of mental health professionals. As a licensed professional, you are responsible for reviewing the scope of practice, including activities that are defined in law as beyond the boundaries of practice in accordance with and in compliance with your professions standards.

All members of the PESI, Inc. planning committee have provided disclosures of financial relationships with ineligible organizations and any relevant non-financial relationships prior to planning content for this activity. None of the committee members had relevant financial relationships with ineligible companies or other potentially biasing relationships to disclose to learners. For speaker disclosures, please see the faculty biography.

California Nurses: PESI, Inc. is a provider approved by the California Board of Registered Nursing, Provider #:17118 for 6.0 self-study contact hours.

You will need to provide your license number to PESI. PESI must have this number on file in order for your hours to be valid.

Florida Nurses: PESI, Inc. is an approved provider by the Florida Board of Nursing. Provider #: FBN2858. These materials qualify for 6.0 self-study contact hours.

Iowa Nurses: PESI, Inc. is an approved provider by the Iowa Board of Nursing. Provider #: 346. Nurses successfully completing these self-study materials will earn 6.3 self-study contact hours.

Copies of the evaluation may be sent to the IBON. You will need to provide your license number to PESI. PESI must have this number on file in order for your hours to be valid.

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Other Professions
This self-study activity qualifies for 6.25 clock hours of instructional content as required by many national, state and local licensing boards and professional organizations. Retain your certificate of completion and contact your board or organization for specific filing requirements.

Disclaimer: **Information obtained in this course should be used within your scope of practice.
**It is your ethical responsibility to report accurate hours to your licensing board.
**All self-study participants must complete and pass (80% or better) a post-test and evaluation prior to receiving a certificate of completion. If you require a copy of the test/evaluation for CE purposes, please print at the time you take the test. Or you may call our customer service department and a copy of your test/evaluation will be emailed to you. Please allow 30-45 days.

Certified Diabetes Educators, Registered Dietitians & Dietetic Technicians, Nurses, Physician Assistants, and other Healthcare Professionals