Effectiveness of a Nurse-Managed Protocol to Prevent Hypoglycemia in Hospitalized Patients with Diabetes

Table 4

Measures to prevent in-hospital hypoglycemic events during subcutaneous insulin treatment, with particular attention to ensuring the recommended intake of carbohydrates in the diet.

(a) Make sure patients eat the expected amounts of carbohydrates in each meal and if they do not eat the whole carbohydrate ration, propose substitutive food with similar carbohydrate content. The following table gives some examples of food containing carbohydrates, easily found in the ward.

Carbohydrates	Type of food	Amount
10 g	Rusks	10 g (2 rusks)
	Breadsticks	15 g (4 breadsticks)
	Yogurt	250 g (2 jars)
	Milk	200 g (1 cup)

(b) If the patient has no appetite or repeatedly eats only part of the food, give prandial insulin at the end of meal in relation to the amount of carbohydrates eaten, according to the following table.

Carbohydrate intake with meal	Prandial insulin to be given at the end of the meal
100%	Prescribed dose
50%	Half the prescribed dose
0%	None

(c) If examinations or procedures requiring fasting are planned, do not give prandial insulin at the missed/skipped meals but start the infusion of a glucose solution following the following table until the patient can resume oral feeding.

Patient’s sex and height	20% glucose solution in a central vein	10% glucose solution in a peripheral vein of good caliber	5% glucose solution in a peripheral vein of small caliber
F 160 cm	16 mL/h	32 mL/h	64 mL/h
F 160 cm; M 175 cm	17 mL/h	35 mL/h	70 mL/h
M 175 cm	19 mL/h	39 mL/h	78 mL/h

The hourly infusion speed of glucose solution is calibrated to provide in 24 hours half the daily carbohydrate requirement set by the diet.