Consistency of Terminology

When patients are admitted to the hospital, we attempt to emulate the same management principles that we teach our patients and their families to do at home.

When possible, we try to use the same carbohydrate coverage method (e.g. I:C ratio vs. Constant Carb method), provide the appropriate hyperglycemia correction with their correction factor, and check for/provide ketone corrections as they would be instructed to do at home. Protocols related to this management are discussed further in Unit 4.

Consistency with how we manage diabetes in the hospital setting and at home is just as important as using the correct terminology when discussing insulin regimens between providers and families. This helps to eliminate confusion about an already complex medical condition that may occur when incorrect terms are used.

When discussing insulin regimens (i.e. during rounds), it is particularly important to clarify what rapid-acting insulin was given for, as the same insulin is utilized to accomplish up to three different tasks:

1. Carbohydrate coverage
2. Hyperglycemia correction
3. Ketone corrections

When discussing the total amount of pre-prandial rapid-acting insulin, one should specifically state:

“’W’ units of insulin were given for ‘X’ grams of carbohydrate coverage and an additional ‘Y’ units of insulin were given for hyperglycemia correction for a total of ‘Z’ units of pre-prandial rapid-acting insulin.”

A common mistake is to misuse the word “correction” when talking about rapid-acting insulin for carbohydrate coverage.

It would be incorrect to say, “8 units of correction was given at Breakfast”, as this statement implies that the entire 8 units of rapid-acting insulin was given for correction of hyperglycemia and that no insulin was provided for carbohydrate coverage at breakfast.

It would be correct to say “6 units of insulin was given for 40 grams of carbohydrate coverage and an additional 2 units of insulin given for hyperglycemia correction for a total of 8 units of insulin given before breakfast.”

Lastly, it is important to remember the difference between hyperglycemia corrections and ketone corrections. Both involve the use of rapid-acting insulin. Neither of them should ever be given at the same time (as discussed in Unit 4).

Figures:

All images in this Chapter are from Flaticon.com; Figure 1, “Consistency of Diabetes Management” was generated by Dr. Alex Tuttle using “home icons” by Freepik and “hospital icons” by Freepik. “English icons” was created by smalllikeart.