Someone posted this on the low carb newsgroup....it *seems* to me that it
ought to apply as well to many T1s who attempt to cover high BG swings after
eating really carby foods. For that reason, I'm posting it here.

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Controlling Blood Sugar in Hospitalized Patients Saves Lives
Media Contact: Melanie Jackson, (859) 323-6363
LEXINGTON, Ky. (April 3, 2006) - If you are not diabetic and you are
hospitalized, your blood sugar level is probably the last thing on
your mind. But the fact is that high blood sugar during
hospitalization for serious illness increases your risk of infection
and death.

Roughly one third of patients experience hyperglycemia, or high blood
sugar, during their hospital stay, and many of those patients don't
have diabetes or are undiagnosed. Blood sugar levels tend to go higher
when a patient is critically ill, for example, after heart surgery - a
condition referred to as stress hyperglycemia. Stress hyperglycemia in
seriously ill patients worsens outcomes - higher medical costs, higher
incidence of infection and readmission to the hospital, and higher
mortality rates.

Until recently there were no national standards of care for managing
hyperglycemia in the inpatient setting. That changed with the 2005
release of the American Diabetes Association's  (ADA) Clinical
Practice Guidelines - the ADA's first guidelines relating to inpatient
hyperglycemic care. By adopting and implementing these guidelines, the
University of Kentucky HealthCare Chandler Medical Center is making
huge strides in assuring that hyperglycemic patients don't fall
through the cracks.

"The effects are immediate. This will help patients now," said Dr.
Raymond Reynolds, co-chair of UK's Glycemic Control Task Force and UK
College of Medicine Associate Professor of Internal Medicine, Division
of Endocrinology and Molecular Medicine. "We are educating physicians,
nurses, pharmacists, dietitians - the entire healthcare team. We're
giving them the tools they need to better treat patients."

The traditional way of dealing with hyperglycemia in non-diabetic
hospitalized patients: Simply not treating it or using sliding scale
insulin treatment. In the sliding scale method, a patient is given an
insulin injection only after his or her blood sugar level has spiked,
without regard for meal schedules or the patient's sensitivity to
insulin. This may cause dangerous highs and lows in the patient's
blood sugar level. In other words, sliding scale insulin treatment is
a method of correction, not control.

"Sliding scale insulin - those are dirty words to an endocrinologist,"
Reynolds said. "It is reactive rather than proactive. Sliding scale
insulin treatment puts a patient on a blood sugar level roller
coaster, and it's a dangerous ride."

Under the new guidelines, nurses and physicians will follow detailed
protocols based on a patient's condition and blood glucose level. For
example, blood glucose levels in critically ill patients will be kept
as close to 110 mg/dl as possible, most likely with intravenous
insulin. Other improvements in patient care include:
    *  So-called ADA Diets will be replaced with Consistent
Carbohydrate diets, which help regulate blood sugar.
    *  A diabetes education plan will be developed for each patient.
    *  Follow-up testing will be planned for patients experiencing
hyperglycemia while in the hospital but not diagnosed with diabetes.

"This is not an overnight change. It requires months of preparation
and education," Reynolds said. "We'll follow outcomes and expect to
see great improvements as a result of our hard work."

Nurses and other staff members will be attending in-service education
sessions through April. An online learning module, designed by Dr.
Reynolds, is available for physicians. In addition, staff across
multiple units have been identified as "Champions" and will serve as
experts on the topic.

The UK Chandler Medical Center will be providing its expertise to
other hospitals in various ways. UK's Glycemic Control Program will
likely be used as a model in hospitals across the state and beyond.
For more information, or to make an appointment, contact the UK
Division of Endocrinology and Molecular Medicine.

http://news.uky.edu/news/display_article.php?category=1&artid=1175