Hyperglycemia, Diabetes, Hypoglycemia, Medication Safety

A Suite of Solutions for a Sweet Solution: A Recipe for Superior Glycemic Management Success

As I was relaxing with my family this holiday season, I had time to watch Cake Boss make a 13-foot gingerbread house and my kids and I baked our own holiday treats, including white chocolate-dipped peppermint bark cookies.

In baking, you start with the right ingredients, review the recipe and bring out the right kitchen tools. Combine everything the right way and a sweet dessert awaits. Miss some steps or ingredients or lack the tools, and the work gets a lot harder – and, the finished product may not be as sweet.

When it comes to glycemic management, this year’s treat arrived with the recipe and ingredients already prepared and packaged up to go.

Back in November 2020, at DTS’s Virtual Diabetes Technology Meeting, l had the opportunity to present predictions for the future of glycemic management as part of a panel called: “Can Glucose Monitoring Predict the Future?” 

If we want to achieve glycemic excellence in the hospital setting, we need to make sure we’re combining the right ingredients, using the right tools and that we have a process that leads to the desired outcome. 

I wanted to remind everyone that the tools to achieve glycemic excellence in the hospital setting are available to us, we just need to learn how to utilize them with the help of a well-designed recipe.

Let’s start with the recipe:

  •       Empower a glycemic team with champions and clear metrics
  •       Utilize effective quality improvement tools
  •       Harness real time data and interventions to achieve high levels of success
  • Layer on available technology, such as insulin management software, to standardize and safely simplify care

This recipe for success is backed up by clinical evidence and the expertise of the leading organizations in the field.

2021 ADA Guidelines for inpatient management recommend continuous IV insulin to reach glycemic targets in the ICU setting, using written or computerized protocols. They list other evidence-based, standard of care recommendations that point us in the right direction but omit the implementation steps needed for success.

In the ICU, errors occur almost 2 x per day per patient, and 61% of those errors are medication related. Nurses are managing multiple high-risk medications, including the top three: anticoagulants, opioids and insulin. For insulin management, many institutions continue to use paper protocols or protocols that require multiple steps or calculations. Nurses are often doing manual calculations at the bedside or navigating through a protocol with dozens of different columns to find the right infusion rate.

These protocols require too many steps to get an accurate insulin infusion rate. In the midst of a pandemic, with higher patient volumes, higher nurse to patient ratios and higher acuity, there needs to be a way to simplify this work.

Trying to work through this as a quality improvement project is one solution, using LEAN or Models for Improvement methodologies. The challenges with QI projects are that 70-80% of them do not meet major objectives. Even if they are successful, they are often not sustainable, and they are time consuming.

In addition, an essential part of improvement is managing metrics and data. You cannot improve what you cannot measure. Most hospitals have little to none glucometrics data.  And, the data they do have is often not meaningful, with perhaps only hypoglycemia reports or retrospective data. For true improvement, process and outcomes data are needed, as well as data in real time to measure and intervene when patient care can be impacted.

With Glucommander, and the eGMS suite of modules, all the missing tools mentioned above are wrapped together. Improvement requires a systems approach, with added layers of solutions to prevent against failures. This is comparable to the Swiss Cheese model of error prevention, with multiple barriers, when working in concert, minimizing the risk of hypoglycemia, and working to lower rates of hyperglycemia.

Glucommander IV has been shown to reduce severe hypoglycemia rates by 99.8%. Glucommander isn’t just insulin management software: it’s a comprehensive package of solutions that add high reliability strategies to achieve the improvement you need.

We work with customer sites to be sure they have the following tools to help achieve success:

  1.     Glycemic Management team with champions
  2.     Workflows to leverage GlucoSurveillance, a real-time tool to identify patients with hyperglycemia that would benefit from being on insulin
  3.     Multidisciplinary Team Rounding: utilizing real-time checklists identify patients with glycemic management needs
  4.     Glucommander software: insulin management software, integrating into your EMR, for ease of use
  5.     Glucommander Reports: to help provide the resources to do real time case reviews
  6.     Glucometrics: delivering regular reports to see how your improvement efforts are doing over time

And once these are all in place, iterate, via process improvement cycles, to continue to improve.

Many of these tools are underutilized, already available in your hospital and in your design of a glycemic improvement program. The added layer for success is the addition of insulin management software that exists today. 

Layering on Glucommander adds a suite of solutions that are like delivering the box of prepped ingredients: a suite of solutions that can become a sweet solution. It makes the hard work of glycemic management a bit easier, with a standardized, proven solution that works.

Current State

Ideal State

No glycemic committee

Glycemic management committee with champions

Lack of communication

Multidisciplinary team with check lists

No clear metrics

Suite of Glucometrics

Retrospective data

GlucoSurveillance: Real-time tools

Order set revisions

Robust process improvement

Paper protocols, SSI only

Glucommander: eGMS, Clinical decision support


Adapted and updated from Davidson et al. ADA 2010, Orlando, June 2010.



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