Successful implementation of these practices can reduce the burden diabetes places on the healthcare system while improving the patient’s quality of life. Coggins, Pharm D, CGP, FASCP, is a director of pharmacy services for more than 300 skilled nursing centers operated by Golden Living and a director on the board of the American Society of Consultant Pharmacists. He was recognized by the Commission for Certification in Geriatric Pharmacy with the 2010 Excellence in Geriatric Pharmacy Practice Award.. Within a few hours, his or her glucose level increases, leaving him or her with long periods of high blood glucose levels.Insulin is then administered with the next glucose check, and blood glucose returns to normal.This “roller coaster” effect of fluctuating glucose levels repeats itself with evidence existing now that these fluctuations are more harmful physiologically than blood glucose levels that are continuously elevated, even when the elevation is considered mild.10 Pushing for Structured Insulin Regimens Best practice guidelines now recommend the use of structured insulin regimens with three components: basal insulin, nutritional insulin, and correctional insulin.Regimens combining these components have been shown to reduce fluctuations in blood glucose levels, increase the number of days patients maintain acceptable blood glucose levels, and reduce the length of non-ICU stays for hospitalized patients.
Diabetes Complications The primary goal of diabetes management is to achieve a level of glycemic control that closely mimics that of nondiabetic patients in an effort to prevent the long- and short-term complications associated with the disease.
The nutritional dose is then added to the correctional dose to obtain the total rapid-acting insulin dose required for that meal.
Additional considerations to further individualize insulin therapy are weight-based correction insulin regimens. Golightly LK, Jones MA, Hamamura DH, Stolpman NM, Mc Dermott MT.
Inadequate blood glucose control over an extended period of time can result in significant long-term complications affecting multiple organ systems with reduced quality of life and increased mortality and morbidity (see Table 1 below).
Short-term complications related to the failure to control glycemic levels can result in symptoms associated with periods of hyperglycemia.