Table 1.

Key Elements to Include in Hospitalwide Glucose Management Policies^*

Hypoglycemia Policy	Hyperglycemia Policy (Subcutaneous [Sub-Q] Insulin)	IV Insulin Infusion Policy	External Sub-Q Insulin Pump Policy
Definition of hypoglycemia Emphasize nurse-driven assessment of conditions that increase risk for hypoglycemia Early recognition and prompt, standardized treatment of hypoglycemia Follow-up glucose monitoring strategy Early notification of prescribers to consider IV dextrose for persistent hypoglycemia Requirement of physicians to review and adjust insulin regimen or discontinue oral antidiabetic agents following a hypoglycemic episode Education of patients on hypoglycemic symptoms and how to prevent future episodes Provision of a snack at bed-time for glucose < 100 mg/dL, with a follow-up glucose check 2 hours later	Definitions: Pre- and postmeal hyperglycemia, DKA, HHS, insulin- deficient patients, components of insulin therapy (for example, basal, nutritional, correction) Require order for A1C on admission if result within last 2–3 months unavailable Indications for IV insulin Fingerstick BG monitoring schedule according to patient’s nutritional status Assessment for signs and symptoms of hyperglycemia Indications for nutrition consultation Diet recommendations Indications for scheduled basal and nutritional insulin Guide to initiating insulin, and estimating total daily insulin requirements. Insulin administration schedule based on nutritional status Definition of appropriate use and schedule of correctional insulin Guidelines on insulin dose titration	Options to choose protocols that target a tight or looser glucose range (for example, 100–140 mg/dL, 140–180 mg/dL) Guidelines for BG monitoring: frequency, site of testing, BG parameters necessitating a confirmatory serum BG Specific guidelines for initiating the drip via a nurse-driven protocol Specific titration parameters for adjusting drip rates for nursing staff Built-in safety guidelines for treatment of hypoglycemia Physician notification parameters relating to persistent hypo- or hyperglycemia, potassium status, and insulin infusion rates Protocol for transition to sub-Q insulin	Requirement of patient to sign insulin pump self-management agreement Notification of physician, and/or legal department, if patient wishes to continue pump therapy but refuses to sign agreement Nurse review of contraindications to initial and continued use of insulin pump therapy Nurse to obtain order via an approved insulin pump order set Upon admission, insulin in the pump replaced with that supplied by the inpatient pharmacy Education of patient on pump self-management in the hospital setting Blood glucose monitoring plan Plan for documenting insulin dose administration by both patient and nurse Ongoing infusion and insertion site management Troubleshooting and managing pump disruptions Delineation of blood glucose criteria and special situations, which warrant discontinuation of insulin pump therapy and transition to sub-Q insulin

^*IV, intravenous; DKA, diabetic ketoacidosis; HHS, hyperglycemic hyperosmolar state; BG, blood glucose; A1C, glycosylated hemoglobin.