---
tags: tier1
---
# Diabetes

## Definition
1. Fasting glucose greater than 126mg/dL
2. Random glucose >200mg/dL
3. A1c >6.5% x2 measurements

## Inpatient Diabetes
:::warning
Hold ALL ORAL meds on admission
:::

First, figure out their total daily dose of insulin. If they're on insulin its just the sum of all the insulin they take every day.

If they're not on insulin at home use **0.5U/kg** as a good starting TDD.

    digraph hierarchy {

        // increases the separation between nodes
        nodesep=0.8 

        //All nodes will this shape and colour
        node [color=Red,fontname=Helvetica,shape=box] 
        edge [color=Blue, style=dashed] //All the lines look like this

        TDD[label = "TDD Insulin"];
        Bolus[label = "Bolus (qAc)"];
        Basal[label = "Basal (qHs)"];
        TDD->{Bolus Basal}
        Basal->2100
        Bolus->0800
        0800->1200
        1200->1800
        
        // Put them on the same level
        {rank=same;Bolus Basal}  
      }

:::danger
If NPO, **hold bolus** insulin but always **give basal**
:::

#### Steroid Hyperglycemia
NPH is often used to treat steroid hyperglycemia in the hospital, its one of the few cases you'll see NPH used.

Its kinetics conveniently match that of prednisone. Typically **0.5U/mg prednisone** (or pred equivalent) is a [good starting place](https://pubmed.ncbi.nlm.nih.gov/34420221/).

### Initial Treatment
:::info
On boards: firstline treatmen is typically *weightloss*.
:::

After failing lifestyle modifications usually Metformin is tried next

#### Insulin Types