Use of Insulin in the Hospital
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In patients with type 1 diabetes, no endogenous pancreatic beta-cell insulin secretory capacity remains. When exogenous insulin is not provided, BG levels have been shown to rise at a rate of 45 mg/dL/hour.19 Exogenous insulin must therefore be administered in continuous fashion to avoid metabolic decompensation and precipitation of diabetic ketoacidosis (DKA).4
Patients with type 2 diabetes may have endogenous insulin secretory capacity that is adequate to control BG levels in conjunction with diet, exercise, and/or oral agent therapy in the outpatient setting. However, when insulin resistance increases and BG levels rise as a result of acute illness or the stress of hospitalization or surgical procedures, endogenous insulin secretory capacity may become inadequate. Insulin supplementation is therefore often necessary to attain targeted BG control.
When it is unclear whether the patient has absolute or relative insulin deficiency, several clinical features derived from patient history may enable physicians to make such a determination. Insulin deficiency is associated with the following clinical features20:
- Wide fluctuations in BG levels
- Episode(s) of diabetic ketoacidosis (DKA)
- Insulin use for more than 5 years
- Diabetes for more than 10 years
