A 68-year-old man with a history of Type 2 diabetes and chronic kidney disease is admitted with congestive heart failure. His usual glycemic targets at home are pre-meal glucose levels of 80-130 mg/dL and peak post-meal levels of less than 180 mg/dL. As a clinical pharmacist, you are consulted to recommend in-hospital glycemic targets for this patient. What would be your recommendation?

A 52-year-old woman with a history of Type 1 diabetes is admitted to the ICU with septic shock. She is on an insulin pump at home. Considering her critical illness, what would be the most appropriate glycemic target for her?

You are the clinical pharmacist on duty when a 47-year-old male patient with a history of Type 2 diabetes is admitted for elective surgery. The patient’s diabetes is managed with subcutaneous regular insulin and metformin. His last dose of regular insulin was administered 4 hours prior to admission. The nursing staff is concerned because his blood glucose level is 250 mg/dL upon admission. You are asked for your input regarding the patient’s insulin management.

Understanding the pharmacokinetics of regular insulin, what would you suggest as the most likely reason for the patient’s elevated blood glucose level and what immediate action would you recommend?

You are a clinical pharmacist consulting on the case of a 58-year-old female patient with Type 1 diabetes, admitted for an acute kidney infection. She manages her diabetes with NovoLog (insulin aspart) before meals and a long-acting insulin analog at bedtime. She took her usual dose of NovoLog 3 hours before lunch, but now, 4 hours post-injection, her blood glucose is reported as 275 mg/dL. The medical team is seeking your advice on the next steps for her diabetes management.

Given your understanding of the pharmacokinetics of NovoLog, what is the most likely explanation for the patient’s hyperglycemia, and what would you recommend?

You are a clinical pharmacist and have been asked to conduct a training session for new healthcare staff. During the session, a question arises about the appropriate timing of insulin administration in relation to meal times. The staff is particularly interested in understanding the differences in onset of action among several insulin types to optimize glycemic control in diabetic patients.

How would you instruct the staff regarding the typical onset of action for the following insulins: regular insulin (Humulin R), insulin aspart (NovoLog), insulin lispro (Humalog), and insulin glargine (Lantus)?