Mendez Carlos E, Umpierrez Guillermo
Assistant Professor of Medicine, Albany Medical College, Director, Diabetes Management Program, Samuel S. Stratton VA Medical Center, Albany, NY.
Hosp Pract (1995). 2013 Aug;41(3):89-100. doi: 10.3810/hp.2013.08.1072.
Patients with type 1 diabetes mellitus (T1DM) have minimal to absent pancreatic β-cell function and rely on the exogenous delivery of insulin to obtain adequate and life-sustaining glucose homeostasis. Maintaining glycemic control is challenging in hospitalized patients with T1DM, as insulin requirements are influenced by the presence of acute medical or surgical conditions, as well as altered nutritional intake. The risks of hyperglycemia, ketoacidosis, hypoglycemia, and glycemic variability are increased in hospitalized patients with T1DM. Diabetic ketoacidosis and severe hypoglycemia are the 2 most common emergency conditions that account for the majority of hospital admissions in patients with T1DM. The association between hyperglycemia and increased risk of complications and mortality in patients with type 2 diabetes (T2DM) is well established; however, the impact of glycemic control on clinical outcomes has not been determined in patients with T1DM who present without ketoacidosis. To decrease complications associated with insulin therapy, health care professionals must be well versed in the use of insulin because it is a common source of medication error. For non-critically ill, hospitalized patients, subcutaneous insulin given to cover basal and prandial needs instead of sliding scale is the preferred method of insulin dosing. Protocols are available for initiating and titrating insulin doses, as well as for transitioning from an insulin infusion to a subcutaneous regimen. In our review, we identify and discuss special considerations related to inpatient glycemic control of non-ketotic patients with T1DM. Additionally, point differences and similarities associated with the management of patients with T2DM are discussed.
1型糖尿病（T1DM）患者的胰腺β细胞功能极少或完全丧失，依赖外源性胰岛素给药来维持充足且维持生命的血糖稳态。对于住院的T1DM患者而言，维持血糖控制颇具挑战，因为胰岛素需求量会受到急性内科或外科疾病以及营养摄入改变的影响。住院的T1DM患者发生高血糖、酮症酸中毒、低血糖和血糖波动的风险会增加。糖尿病酮症酸中毒和严重低血糖是导致T1DM患者住院的2种最常见的紧急情况。2型糖尿病（T2DM）患者中，高血糖与并发症风险增加及死亡率升高之间的关联已得到充分证实；然而，对于未发生酮症酸中毒的T1DM患者，血糖控制对临床结局的影响尚未明确。为减少与胰岛素治疗相关的并发症，医护人员必须精通胰岛素的使用，因为胰岛素是用药错误的常见源头。对于非危重症住院患者，皮下注射胰岛素以满足基础和餐时需求而非采用按血糖水平调整剂量的方法是首选的胰岛素给药方式。有启动和调整胰岛素剂量以及从胰岛素输注过渡到皮下给药方案的相关规程。在我们的综述中，我们识别并讨论了与非酮症T1DM患者住院期间血糖控制相关的特殊注意事项。此外，还讨论了与T2DM患者管理相关的异同点。
