title: Effectiveness of a nurse-managed protocol to prevent hypoglycemia in hospitalized patients with diabetes.
abstract: BACKGROUND
  Hypoglycemia due to inadequate carbohydrate intake is a frequent complication of insulin treatment of diabetic in-patients. Objective. To assess the effectiveness of a nurse-managed protocol to prevent hypoglycemia during subcutaneous insulin treatment.
  
  
  METHODS
  Prospective pre-post-intervention study.
  
  
  METHODS
  In 350 consecutive diabetic in-patients the incidence of hypoglycemia (blood glucose < 70 mg/dL) during subcutaneous insulin treatment was assessed before (phase A) and after (phase B) the protocol was adopted to permit (1) the patient to opt for substitutive food to integrate incomplete carbohydrate intake in the meal; (2) in case of lack of appetite or repeatedly partial intake of the planned food, prandial insulin administered at the end of the meal to be related to the actual amount of carbohydrates eaten; (3) intravenous infusion of glucose during prolonged fasting.
  
  
  RESULTS
  Eighty-four patients in phase A and 266 in phase B received subcutaneous insulin for median periods of, respectively, 7 (Q1-Q3 6-12) and 6 days (Q1-Q3 4-9). Hypoglycemic events declined significantly from 0.34 ± 0.33 per day in phase A to 0.19 ± 0.30 in phase B (P > 0.001).
  
  
  CONCLUSIONS
  A nurse-managed protocol focusing on carbohydrate intake reduced the incidence of hypoglycemia in patients with diabetes receiving subcutaneous insulin in hospital.
authors.affiliation: Diabetes and Metabolic Diseases Unit, Ospedale di Desio, Desio, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Marelli
authors.affiliation: Division of Cardiology and Intensive Cardiac Care Unit, Ospedale di Desio, Desio, Italy ; IRCCS-Istituto di Ricerche Farmacologiche "Mario Negri", Via Giuseppe La Masa 19, 20156 Milan, Italy.
authors.forename: Fausto
authors.initials: F
authors.lastname: Avanzini
authors.affiliation: Division of Cardiology and Intensive Cardiac Care Unit, Ospedale di Desio, Desio, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Iacuitti
authors.affiliation: Division of Cardiology and Intensive Cardiac Care Unit, Ospedale di Desio, Desio, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Planca
authors.affiliation: Division of Cardiology and Intensive Cardiac Care Unit, Ospedale di Desio, Desio, Italy.
authors.forename: Ilaria
authors.initials: I
authors.lastname: Frigerio
authors.affiliation: Division of Cardiology and Intensive Cardiac Care Unit, Ospedale di Desio, Desio, Italy.
authors.forename: Giovanna
authors.initials: G
authors.lastname: Busi
authors.affiliation: Division of Cardiology and Intensive Cardiac Care Unit, Ospedale di Desio, Desio, Italy.
authors.forename: Liliana
authors.initials: L
authors.lastname: Carlino
authors.affiliation: IRCCS-Istituto di Ricerche Farmacologiche "Mario Negri", Via Giuseppe La Masa 19, 20156 Milan, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Cortesi
authors.affiliation: IRCCS-Istituto di Ricerche Farmacologiche "Mario Negri", Via Giuseppe La Masa 19, 20156 Milan, Italy.
authors.forename: Maria Carla
authors.initials: MC
authors.lastname: Roncaglioni
authors.affiliation: IRCCS-Istituto di Ricerche Farmacologiche "Mario Negri", Via Giuseppe La Masa 19, 20156 Milan, Italy.
authors.forename: Emma
authors.initials: E
authors.lastname: Riva
mesh_terms: D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000032:analysis; D003920:Diabetes Mellitus / Q000097:blood / Q000188:drug therapy* / Q000451:nursing; D006760:Hospitalization; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000188:drug therapy* / Q000451:nursing; D007003:Hypoglycemia / Q000097:blood / Q000139:chemically induced* / Q000451:nursing / Q000517:prevention & control*; D007004:Hypoglycemic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D007328:Insulin / Q000009:adverse effects* / Q000097:blood / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin