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Diabetes Comorbidity (Pediatric Inpatient)
Clinical Description
- Care of the hospitalized child with a known history of diabetes requiring glycemic monitoring and management.
Key Information
- Carbohydrate-counting or carbohydrate-consistency has replaced the previous ADA (American Diabetes Association) calorie-restrictive diet (e.g., 1800 calorie ADA diet).
- For patients who are on insulin pump therapy or insulin therapy, the total carbohydrate content of meals and snacks is a major determinant of premeal insulin dose.
- Antihyperglycemic agents are not recommended for the hospitalized patient. Oral agents provide minimal flexibility and cannot be adjusted when there are sudden or unexpected events that may occur during hospitalization.
- For hypoglycemia treatment, standards recommend providing a “fast-acting” carbohydrate and to retest within 15 minutes to ensure blood glucose level has stabilized per organizational protocol.
Clinical Goals
By transition of careA. The patient will achieve the following goals:
Blood Glucose Level Within Targeted Range
- Education: Comorbidity: Self-Management
Correlate Health Status
Correlate health status to:
- history, comorbidity, congenital anomaly
- age, developmental level
- sex, gender identity
- baseline assessment data
- physiologic status
- response to medication and interventions
- psychosocial status, social determinants of health
- barriers to accessing care and services
- child and family/caregiver:
- health literacy
- cultural and spiritual preferences
- safety risks
- family interaction
- plan for transition of care
Diabetes Comorbidity
Signs/Symptoms/Presentation
- Medical history of type 1 or type 2 diabetes
Problem Intervention
Monitor and Manage Glycemia
- Establish target blood glucose levels based on patient-specific factors, such as age, developmental stage and illness severity.
- Document blood glucose levels and monitor trend; advocate for adjustment to keep within targeted range.
- Provide pharmacologic therapy to maintain blood glucose levels within targeted range.
- Check blood glucose level if there is a change in mental or cognitive status.
- Recognize, treat and document hypoglycemia event and potential cause.
- Avoid hypoglycemic episodes by advocating for insulin dose adjustment when there is a change in condition, such as illness severity, decreased oral intake, missed or refused meals and snacks, as well as medication change that may include steroid taper.
- Encourage family participation in glycemic management.
Associated Documentation
- Glycemic Management
Education
CPG-Specific Education Topics
Comorbidity: Self-Management
adherence to disease management plan
when to seek medical attention
General Education Topics
General Education
admission, transition of care
orientation to care setting, routine
advance care planning
diagnostic tests/procedures
diet modification
opioid medication management
oral health
medication management
pain assessment process
safe medication disposal
tobacco use, smoke exposure
treatment plan
Safety Education
call light use
equipment/home supplies
fall prevention
harm prevention
infection prevention
MDRO (multidrug-resistant organism) care
personal health information
resources for support
References
- American Diabetes Association. American Diabetes Association Standards of Medical Care in Diabetes--2021. Diabetes Care. 2021, January;44(1), S1-S232. Source[Clinical Practice Guidelines]
- American Diabetes Association. American Diabetes Association Standards of Medical Care in Diabetes--2021. Diabetes Care. 2021, January;44(1), S1-S232. Source[Clinical Practice Guidelines]
- Chiang, J. L.; Maahs, D. M.; Garvey, K. C.; Hood, K. K.; Laffel, L. M.; Weinzimer, S. A.; Wolfsdorf, J. I.; Schatz, D. Type 1 diabetes in children and adolescents: A position statement by the American Diabetes Association. Diabetes Care. 2018;41(9), 2026-2044. doi:10.2337/dci18-0023 Source[Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
- Cruz, P.; Blackburn, M. C.; Tobin, G. S. A systematic approach for the prevention and reduction of hypoglycemia in hospitalized patients. Current Diabetes Reports. 2017;17(11), 117. doi:10.1007/s11892-017-0934-8 Source[Metasynthesis,Meta-analysis,Systematic Review]
- Davis, G. M.; Galindo, R. J.; Migdal, A. L.; Umpierrez, G. E. Diabetes Technology in the Inpatient Setting for Management of Hyperglycemia. Endocrinology Metabolic Clinics of North America. 2020;49(1), 79-93. doi:10.1016/j.ecl.2019.11.002 Source[Expert/Committee Opinion]
- De Buck, E.; Borra, V.; Carlson, J. N.; Zideman, D. A.; Singletary, E. M.; Djärv, T. First aid glucose administration routes for symptomatic hypoglycaemia. Cochrane Database of Systematic Reviews. 2019;(4) doi:10.1002/14651858.CD013283.pub2 [Metasynthesis,Meta-analysis,Systematic Review]
- DiMeglio, L. A.; Acerini, C. L.; Codner, E.; et al. ISPAD Clinical Practice Consensus Guidelines 2018: Glycemic control targets and glucose monitoring for children, adolescents, and young adults with diabetes. Pediatric Diabetes. 2018;19(Suppl. 27), 105-114. doi:10.1111/pedi.12737 Source[Quality Measures,Clinical Practice Guidelines]
- Gordon, C. Blood glucose monitoring in diabetes: Rationale and procedure. British Journal of Nursing. 2019;28(7), 434-439. doi:10.12968/bjon.2019.28.7.434 Source[Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
- Handelsman, Y.; Bloomgarden, Z. T.; Grunberger, G.; Umpierrez, G.; Zimmerman, R. S.; Bailey, T. S.; Blonde, L.; Bray, G. A.; Cohen, A. J.; Dagogo-Jack, S.; Davidson, J. A.; Einhorn, D.; Ganda, O. P.; Garber, A. J.; Garvey, W. T.; Henry, R. R.; Hirsch, I. B.; Horton, E. S.; Hurley, D. L.; Jellinger, P. S.; Jovanovič, L.; Lebovitz, H. E.; LeRoith, D.; Levy, P.; McGill, J. B.; Mechanick, J. I.; Mestman, J. H.; Moghissi, E. S.; Orzeck, E. A.; Pessah-Pollack, R.; Rosenblit, P. D.; Vinik, A.; Wyne, K.; Zangeneh, F. American association of clinical endocrinologists and american college of endocrinology - clinical practice guidelines for developing a diabetes mellitus comprehensive care plan - 2015. Endocrine Practice. 2015;21(s1), 31778. doi:10.4158/EP15672.GL [Quality Measures,Clinical Practice Guidelines]
- Healthcare Improvement Scotland. (2010, Updated 2017). 116-Management of diabetes a national clinical guideline. Source[Quality Measures,Clinical Practice Guidelines]
- Laffel, L. M.; Limbert, C.; PHelan, H.; Virmani, A.; Wood, J.; Hofer, S. E. ISPAD Clinical Practice Consensus Guidelines 2018: Sick day management in children and adolescents with diabetes. Pediatric Diabetes. 2018;19, 193-204. doi:10.1111/pedi.12741 [Quality Measures,Clinical Practice Guidelines]
- Lake, A.; Arthur, A.; Byrne, C.; Davenport, K.; Yamamoto, J. M.; Murphy, H. R. The effect of hypoglycaemia during hospital admission on health-related outcomes for people with diabetes: A systematic review and meta-analysis. Diabetic Medicine. 2019;36, 1349-1359. doi:10.1111/dme.14115 Source[Metasynthesis,Meta-analysis,Systematic Review]
- Marks, B. E.; Wolfsdorf, J. I. Monitoring of pediatric type 1 diabetes. Frontiers in Endocrinology. 2020;11(128) doi:10.3389/fendo.2020.00128 Source[Review Articles]
- National Institute for Health and Care Excellence. (2015). Diabetes (type 1 and type 2) in children and young people: Diagnosis and management. Source[Quality Measures,Clinical Practice Guidelines]
- Panagiotopoulos, C.; Hadjiyannakis, S.; Henderson, M. Type 2 diabetes in children and adolescents. Canadian Journal of Diabetes. 2018;42, S247-S254. doi:10.1016/j.jcjd.2017.10.037 [Quality Measures,Clinical Practice Guidelines]
- Phelan, H.; Lang, K.; Cengiz, E.; Gallego, P.; Majaliwa, E.; Pelicand, J.; Smart, C.; Hofer, S. E. ISPAD Clinical Practice Consensus Guidelines 2018: Diabetes education in children and adolescents. Pediatric Diabetes. 2018;19(Suppl 27), 75-83. doi:10.1111/pedi-12762 Source[Quality Measures,Clinical Practice Guidelines]
- Pratiwi, C.; Mokoagow, M. I; Kshanti, I. A. M.; Soewondo, P. The risk factors of inpatient hypoglycemia: A systematic review. Heliyon. 2020;6 doi:10.1016/j.heliyon.2020.e03913 Source[Review Articles]
- Pérez, A.; Ramos, A.; Carreras, G. Insulin therapy in hospitalized patients. American Journal of Therapeutics. 2020;27(1), e71-e78. doi:10.1097/MJT.0000000000001078 [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
- Srinivasan, V.; Agus, M. S. D. Tight glucose control in critically ill children - A systematic review and meta-analysis. Pediatric Diabetes. 2014;15(2), 75-83. doi:10.1111/pedi.12134 [Metasynthesis,Meta-analysis,Systematic Review]
- Wherrett, D. K.; Ho, J.; Huot, C.; Legault, L.; Nakhla, M.; Rosolowsky, E. Type 1 diabetes in children and adolescents. Canadian Journal of Diabetes. 2018;42, S234-S246. doi:10.1016/j.jcjd.2017.10.036 [Quality Measures,Clinical Practice Guidelines]
- Wolfsdorf, J. I.; Glaser, N.; Agus, M.; Fritsch, M.; Hanas, R.; Rewers, A.; Sperling, M. A.; Codner, E. ISPAD Clinical Practice Consensus Guidelines 2018: Diabetic ketoacidosis and the hyperglycemic hyperosmolar state. Pediatric Diabetes. 2018;19(Suppl 27), 155-177. doi:10.1111/pedi.12701 [Quality Measures,Clinical Practice Guidelines]
Disclaimer
Clinical Practice Guidelines represent a consistent/standardized approach to the care of patients with specific diagnoses. Care should always be individualized by adding patient specific information to the Plan of Care.
