Nonpharmacologic Therapy
Nutrition Management
Nutrition therapy is a critical first-line intervention for inpatients with hyperglycemia. Key priorities include:
- Avoiding prolonged fasting – Patients should receive scheduled mealtime nutrition or continuous enteral/parenteral feeding.
- Coordinating carbohydrate intake with insulin therapy – Matching prandial insulin doses to carbohydrate content helps prevent post-meal hyperglycemia.
- Assessing oral intake – Poor oral intake necessitates reducing or holding prandial insulin to prevent hypoglycemia.
Clinical pharmacists play a vital role in collaborating with nutrition services to match the nutrition care plan with the pharmacotherapy regimen.
Identifying Contributing Factors
It is imperative to identify factors driving hyperglycemia in each patient, as addressing these issues constitutes initial management:
- Hold glucocorticoid therapy, if possible.
- Treat infections or other underlying illnesses provoking a stress response.
- Discontinue medications that worsen glucose control (e.g. octreotide).
- Consider undiagnosed type 1 diabetes or latent autoimmune diabetes in adults (LADA) in patients with severe hyperglycemia without prior diabetes history. These may require insulin.
- Lifestyle Management
Encouraging physical activity within patients’ functional capacity and promoting adequate rest and sleep hygiene helps improve insulin sensitivity and glycemic control. Stress management is also beneficial.
In summary, nutrition adjustments, resolving reversible hyperglycemia triggers, medication changes, activity, rest, and addressing stress constitute the foundation of non-pharmacological management. Clinical pharmacists play a vital role in helping implement these interventions in collaboration with the healthcare team.