[Management of hyperglycemia in the non-critical hospitalized patients with oral feeding]

Abstract

A 67-year-old woman with a history of hypertension, hyperlipidemia and 6 years of evolution of type 2 diabetes mellitus presented with fever, purulent sputum and right chest pain. She was on treatment with metformin 850 mg/bid, glimepiride 4 mg/day, candesartan 16 mg/day, atorvastatin 10mg/day and acetylsalicylic acid 100mg/day. Standing out in the physical examination was blood pressure 90/50 mmHg, temperature 38.6 °C, pulse 112/min, respirations 24/min, weight 8 5 kg, height 1.68 m. She had crackling rales in the right lung-base and edema in lower limbs. The blood analysis showed leukocytosis, glucose 348 mg/dl, urea 70 mg/dl, creatinine 1.5mg/dl and HbA1c 8.4%. A chest x-ray revealed condensation in the lower lobe of the right lung. Antibiotic treatment was begun, maintaining an oral diet from admission. What is the best strategy regarding the treatment of this patient's hyperglycemia, its management and what evidence is there on this subject?