The purpose of this presentation is to update the audience to the latest evidence supporting tools and targets to optimize the management of hyperglycemia for hospitalized or perioperative patients. We will discuss the current guidelines for establishing glycemic targets in the acute care setting, along with some of their historical context. A discussion of physiologic insulin replacement, anchored on the concepts of basal, nutritional and corrective insulin replacement will be followed by interactive case presentations to underscore various common, and often tricky to manage, scenarios such as how to handle NPO patients, patients on enteral feeds and patients with corticosteroid-exacerbated hyperglycemia. We will begin our discussion of perioperative diabetes management by reviewing the evidence linking hyperglycemia to poor outcomes and examine glycemic targets both in preparation for elective surgery and for the perioperative period. Additionally, we will discuss perioperative management strategies, including what to advise patients coming in for surgery, appropriate insulin management strategies and some of the ongoing efforts to optimize glycemia at Parkland Hospital.

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