Glycemic Management Myth Busters

Our experts debunk the biggest myths surrounding inpatient glycemic management and share their strategies!

Lori Weiss: Good afternoon, I'm Lori Weiss, the Director of the Clinical Project Leads, and it's my privilege to introduce our esteemed team today. Our team is comprised of highly skilled nurses who are true experts in inpatient diabetes management and they have led numerous successful Glucommander project implementations.

We play a pivotal role in guiding our clients through the process of preparing and implementing Glucommander within their healthcare systems. Our focus is on facilitating the clinical aspects of the project which includes, but is not limited to order set adjustments and changes in clinical workflows.

We work closely with our clients to ensure they are well prepared for the go live phase, and we leverage our expertise to make every Glucommander implementation a success. 

Our collective experience. Glytec is truly exceptional with a combined 125 years of nursing experience, 60 years in diabetes care, 43 years in leadership roles, and a remarkable 24 year history at Glytec.

Our nursing backgrounds span a wide spectrum including trauma ICU, CVICU, pediatric ICU, the emergency department, med surg, and diabetes education. Today, we are thrilled to share the top 10 glycemic management mythbusters, insights that will help you navigate the world of inpatient diabetes management with clarity and confidence.

Now Tiffany will begin by sharing myth 10.

Tiffany Young: Myth number 10, glycemic management isn't as important as other conditions and can be prioritized as time allows. According to the CDC, 37.3 million people in the United States have diabetes. That is 11.3 percent of our population. And most of us know that a quarter of the patients admitted to the hospital at any given time have diabetes.

The hospital admission rates for people with diabetes is between 2 to 6 times higher than people without diabetes. And additionally, a dollar out of every 4 in U. S. healthcare costs is spent caring for people with diabetes, with a total of 237 billion spent on direct medical costs and another 90 billion on reduced productivity.

30 percent of the total medical costs can be attributed to hospital inpatient care. And on average, people with diabetes have a 2.3 times greater health care costs than those without diabetes. And overall, the management of diabetes is important to prevent other long term conditions like heart disease, stroke, kidney, kidney disease, worsening of a patient's visions and even neuropathy. 

The management of diabetes while a patient is hospitalized is also important because improper management could lead to longer lengths of stay, which ultimately increases mortality and the risk of hospital acquired infections. Now I'm going to pass it to Jeannine.

Jeannine Streetman: Myth number nine. Implementing technology like eGMS takes away our ability to personalize or customize patient care. Technology is a tool to support clinical teams, not replace the team's ability to provide and manage care. Glucommander does allow the ability to customize and personalize the glycemic management for patients.

This is still provider driven. But the insulin sensitivity varies from patient to patient. As a CPL, we partner with our customers to build order sets customized to your facility. We focus on what your current policies and procedures are. Anything that's working well, we'll keep those and incorporate Glucommander process.

Glucommander has a total of 8 multiplier options, 5 for IV and 3 for SubQ. Glucommander allows the provider to choose the most appropriate multiplier for that specific patient when ordering Glucommander. In addition, Glucommander also allows the provider a custom option for use in ordering Glucommander SubQ with a specific dose.

In addition to the 8 multipliers, Glucommander also has customized target ranges for specific patient populations. For example, the management of a patient in the OB population, Glucommander IV has a target range of 80 to 120. For the patient with increased risk of hypoglycemia admitted with DKA, the provider will likely order a target range of 140 to 180.

In summary, Glucommander recommends a precise insulin dose based on the patient's insulin sensitivity and the glucose target range ordered by the provider. I'm going to now pass it to Jonathan.

Jonathan Clarke: Alright, myth number eight, glycemic management is only important for patients with type 1 diabetes or patients who experience extreme glycemic excursions.

So managing blood sugar levels is essentially for all patients in the hospital, not just for those with type 1 diabetes or extreme blood sugar fluctuations. High blood sugar levels or hyperglycemia can occur for patients with various levels of stress, when they're critically ill or battling infection, or because of certain medications.

This can lead to complications like prolonged infections, delayed or prolonged healing processes, and longer hospital stays. Almost 40 percent of patients who are in the hospital require insulin to control their blood sugar. The need for insulin therapy is not limited to specific hospital areas, but applies to every unit in every hospital, including your facility.

So from an effective strategy standpoint, that is really important that we have that everywhere. By using eGMS technology to identify individuals who need insulin and monitor trends, hospitals can make sure that every patient receives the best care possible. When we become more effective and efficient at managing blood sugars in the hospital, we lower the risks of many complications for all patients. This is a critical step in ensuring that every patient who needs insulin in the hospital has the smoothest and fastest recovery possible. Over to you, Jeannine.

Jeannine Streetman: Myth number seven. Clinical decision support tools, insulin calculators, and eGMS are all the same thing.

eGMS offers a complete package from start to finish. Glytec's eGMS centers on Glucommander, but you get access to our entire suite of modules to support insulin dosing software, including Glucometrics,

You'll also want to look for that tool that you know is safe and secure. The other tools in the market, like rudimentary insulin calculators and other homegrown solutions, most hospitals leverage these, but might not be aware that these tools are also subject to FDA regulation. Glytec's eGMS is the only cloud based solution, FDA-cleared software, able to personalize IV and SubQ insulin dosing support for patients with and without diabetes.

What kind of implementation and support do you need? Glytec has a robust team of clinicians that assist with building order sets, reviewing nursing, pharmacy, and provider workflows, preparing education for all, and at the elbow support during deployment. In addition to the clinical team, we have an awesome technical team that assists with integration, interfaces, and builds.

Additionally, we know glycemic management isn't a nine to five job, and our support does not stop with the go live. Our partners also get support from our support team, a 24/7 phone line to reach out to Glytec clinical, technical, and engineering staff when things may not operate as planned. Lastly, each Glucommander partner receives a customer clinical support manager to assist and guide through the glycemic journey following that Glucommander implementation.

Of note, we do consider our clients to be partners in the glycemic management journey as we all work together to stamp out hyper and hypoglycemia to improve the lives of patients with diabetes. I'm going to now pass it to Jonathan.

Jonathan Clarke: All right. Myth number six. Prioritizing other aspects of care is fine, since inpatient stays are usually only a couple of days.

Well, glycemic management in the hospital is extremely important, especially for patients staying just a few days. Prioritizing this... Helps promote healing, reduce risk, prevent complications, and many other things that could occur during hospitalization. So, people in the hospital are at their most vulnerable state and at their highest risk for harm.

Much more so than when they're at home. So with that in mind, inpatient glycemic management should be viewed as a top priority. We cannot assume that they'll get the right care or figure it out once they leave the hospital. We should act like this is their only chance to see things happen the right way for things to happen the right way.

This is it. This is it. This is what we do. Managing blood sugar levels in the hospital makes a big difference even after patients leave. Studies prove that patients who keep their blood sugar levels stable in the hospital tend to recover faster and go home sooner. They are less likely to end up back in the hospital soon after leaving.

Additionally, managing blood sugar levels while in the hospital is a great opportunity to teach patients about their diabetes. They learn good habits they can use at home and how to handle their condition the right way. And this education is key because it helps them stay healthier in the long run, reducing the chance of new problems down the road.

While taking care of blood sugar outside the hospital is crucial, what we do inside the hospital is vital as well. It's not just about preventing complications during stay, it's about ensuring patients overall health, both in the short term and in the future. Proper inpatient glycemic management is a major part of giving patients the best shot at staying healthy and avoiding additional concerns down the road. Now over to you, Tiffany.

Tiffany Young: Myth number five. Sliding scale works fine for managing our patients. Sliding scale might be simpler and more convenient to order for providers, but it is not safe for the patient, especially for patients with type 1 diabetes who need both basal and bolus insulin.

Sliding scale is a reactive approach to diabetes management and is utilized to address an already elevated blood glucose. Basal bolus management, which is the standard of care, is a proactive approach to diabetes management, where long acting insulin is used to stabilize the blood glucose throughout the night and between meals.

The prandial insulin is utilized to help prevent the blood glucose from spiking due to ingested carbohydrates. and the correctional or sliding scale insulin should be utilized in the event that the blood glucose is elevated prior to the meal. Most are familiar with the Rabbit 2 study, which was a prospective randomized trial that compared the efficacy and safety of the basal bolus insulin to sliding scale insulin.

Mean durations of hospital stays were similar, but patients who received basal bolus insulin exhibited a greater improvement in their glycemic control than those who received sliding scale insulin only. The mean glucose was significantly higher in those treated with sliding scale insulin alone, where 66 percent of the patients who received basal bolus insulin achieved that mean glucose target of less than 140 milligrams per deciliter, and only 38 percent of those receiving sliding scale insulin only achieved that same target.

Each group had two hypoglycemic events of less than 60 milligrams per deciliter, and no severe hypoglycemia of less than 40. This study alone shows that the patients can achieve target ranges safely with basal bolus insulin therapy with the same amount of hypoglycemia as sliding scale alone. The ADA also recommends basal bolus insulin therapy for non critically ill patients and strongly discourages the use of sliding scale insulin.

They also recommend that insulin should be administered using a validated written or computerized protocol that allows for predefined adjustments in the insulin dosage based on glycemic fluctuations. Now let's pass it to Leigh Ann.

Leigh Ann Brooks: Myth number four. Using basal bolus therapy will lead to more hypoglycemia.

It's not okay to let patients' blood sugars remain elevated because of the fear of hypoglycemia. As clinicians, it's important that we are treating patients to the standard of care, which is basal bolus therapy. Just as Tiffany mentioned previously, evidence shows that there is not a risk of increased hypoglycemia versus using sliding scale alone.

Thank you. We know that time and range for blood glucose is so important, and when patients have a hypoglycemic event, evidence shows that it can increase their length of stay,an average of 4.1 days, if not treated correctly. When a patient is experiencing a hypoglycemic event, it's important to treat it properly.

Then it's imperative to do a recheck of the blood glucose after treatment to make sure that they are responding appropriately. This is where utilizing technology like an eGMS or an electronic glucose management system can help streamline your care. Glucommander will provide alerts to remind you to do a hypoglycemic check and once you enter the blood glucose, Glucommander will dynamically change the dose to get the patient into the target range safely.

Ultimately, if we aren't treating our patients correctly in the hospital, it can have a negative and unintended consequence for how they are caring for themselves at home. As patients see how we model glycemic control or don't model it in the hospital, this may be how they model their treatment for their diabetes at home.

I will now pass to Matthew.

Matthew DeJong: Myth number three, counting carbs is more work than it's worth. Precision in dose. Insulin is a hormone that regulates blood sugar levels by allowing glucose to enter the cells for energy. Carbohydrates directly influence blood sugar levels as they are broken into glucose during digestion. By counting carbs and matching the insulin dose accordingly, individuals with diabetes can more precisely manage their blood sugar levels.

Basal bolus, which is the standard of care, depends on the accurate counting of carbs to have precise dosing. Personalized control. Different foods contain varied amounts of carbohydrates. which can impact post meal blood sugar levels differently. Carb counting allows individuals to tailor their insulin dosages to their specific dietary choices, promoting personalized diabetes management, stabilizing post meal spikes.

After consuming a meal, blood sugar levels tend to rise. By administering insulin in proportion to the carb intake, individuals can mitigate these post meal spikes and maintain more stable blood sugar levels throughout the day. Preventing hypoglycemia. Administering too much insulin without considering carb intake can lead to hypoglycemia.

Carb counting helps prevent overcorrection and lowers the risk of dangerously low blood sugar episodes. Improved A1C levels. Consistently pairing carb counting with insulin administration can lead to better long term blood sugar control and reflects in lower A1C levels. This is essential for reducing the risks of diabetes related complications.

Enhancing quality of life. Precise blood sugar management through carb counting and insulin administration can lead to improved overall well being. Stabilized blood sugar levels reduce symptoms like fatigue, frequent urination, excessive thirst, and mood swings. Contributing to a better quality of life for individuals with diabetes.

Individual empowerment. Carb counting empowers individuals with diabetes to take an active role in their management. It provides them with the knowledge and the skills needed to make informed decisions about their diet and insulin needs. Pairing Carb counting with insulin administration is vital for achieving optimal blood sugar control, preventing hypoglycemia and reducing the risk of complications associated with diabetes.

It empowers individuals to manage their condition effectively and maintains a better quality of life. Leigh Ann, back over to you.

Leigh Ann Brooks: Myth number two, the CMS measures related to hyperglycemia will lead to more hypoglycemia. You will see the two CMS measures here on your screen. These measures are designed to increase focus on prolonged hyperglycemia that could inhibit a patient's ability to recover and measure hospital-caused adverse drug effects.

We know that these CMS measures are only the tip of the iceberg. We expect more measures to follow and that they'll increase in specificity. These are welcome regulations because they are putting a spotlight on inpatient glycemic management overall in a way that should raise the level of visibility and allocated resources.

This will ultimately benefit hyperglycemia, hyperglycemia, and all aspects of diabetes care. If we have any doubts, we can look to our history. When past CMS measures were put into place for other disease states, such as sepsis and hospital acquired infections, dramatic improvements and outcomes followed.

We have every reason to believe that in time, the same will be true for the CMS glycemic measures and diabetes care. Matthew, back to you.

Matthew DeJong: We're going along with the status quo because we don't have the people, resources, or bandwidth to adopt new technology and facilitate change. We know firsthand that it can be intimidating to take on a project like new technology. But you don't need to reinvent the wheel. The wheel exists. We get it.

Change management is hard, and we know that there's a fear that new technology can disrupt established workflows. This isn't something you need to tackle alone. At Glytec, this is what we do. We aren't just going to give you a product in an owner's manual and walk away. We have a blueprint for success. An implementation team of clinical consultants who will work with you elbow to elbow, getting you set up for success.

And remember, once implemented, you'll be assigned a clinical success manager who will be your long term consultant to ensure continuous improvement from all angles, people, process, and technology. We also cannot stress enough the importance of finding technology that is safe and effective. Set yourself up for success with a tool that is FDA-cleared, HIPAA compliant, HITRUST certified and built with safety in mind for both your patients and your staff. 

Glytec's team of technical experts will already have done the heavy lifting to ensure your product is EHR agnostic and compatible within the cloud. We have you covered and can provide the documentation you need to work with your IT department, your CIO, or CTO.

We know if you're here with us today, you understand the importance of inpatient glycemic management and want to provide the best care for your patients. Yes, it might be easier to stick with the status quo due to the limited time, resources, and bandwidth. However, achieving the standard of care may seem impossible.

But I assure you, it is possible with the right partner by your side. Now back to you.

Lori Weiss: I want to thank our team for providing these glycemic management insights. As you may have seen, our theme for Time to Target this year is the glycemic management journey. And as you've heard from our team, you don't have to go on this journey alone.

You want the right tools, resources, and guides to help you along the way. Well, we are here for you. No other insulin therapy software company has more clinicians on staff than Glytec. If you've already partnered with us, then you know that we are here to help you. And if you haven't partnered with us yet, our team looks forward to working with you in the future to provide you with the right people, processes, and technology to make every step of your glycemic management journey a little bit easier.

On behalf of our amazing group of clinical project leads and the entire Glytec team, thank you so much for joining us today, and we hope you enjoy the rest of Time to Target.

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