Carbohydrate Consumption as a Factor in Aspart Dosing

• Status: Completed
• Trial end date: 2012-12-01
• Target enrollment: 0
• Participant gender: All

Summary

Good sugar control in postoperative hospitalized patient has been shown to improve wound healing and infection rates. However, sugar control is difficult to achieve and suboptimal use of insulin is thought to be a contributory factor. Though it is known that generally the consumption of carbohydrates alone raises the blood sugar, the usual practice of dosing meal-time insulin is based on the fraction of the total meal-tray eaten which includes proteins, fats and carbohydrates. This leads to an overestimation of insulin required for a patient who consumes a portion of mainly proteins and fats on their trays or an underestimation for those eating mainly the carbohydrates on their tray. Low sugars or high blood sugars can follow respectively.

Hypothesis: The purpose of this study is to see if dosing meal-time insulin based on grams of carbohydrates consumed will result in better sugar control compared to the usual practice of dosing meal-time insulin based on percent of total meal consumed in hospitalized patients.

• Phase: Phase 4
• Accepts Healthy Volunteers?: No

Details

• Lead Sponsor: Rush University Medical Center
• Treatments: Insulin; Insulin Aspart; Insulin degludec, insulin aspart drug combination; Insulin, Globin Zinc; Insulin, Long-Acting

Criteria

Inclusion Criteria:

• Adults aged > or = to 18 admitted to general surgical floors, excluding the ICU, at Rush University Medical Center, regardless of race, ethnicity, gender

• Clinical diagnoses of type 2 diabetes for more than 6 months prior to admission

• Treated with insulin and/or 2 or more oral diabetic agents

• Estimated length of stay 3 days or more

• Postoperative point of care blood glucose of > 180 mg/dL

Exclusion Criteria:

• Glomerular Filtration Rate < 60 based on MDRD equation

• Pregnant patients

• Receiving parenteral or enteral nutrition

• Patients with an admitting diagnosis of hypoglycemia

• Outpatient insulin < 0.5 units/kg/day

• Inability to give consent

• Severe liver disease

• Known hypopituitarism or adrenal insufficiency

• Treatment with Prednisone at dose > 5 mg daily or its equivalent