Paper
Tuesday, November 6, 2007
605
Hyperglycemia Management and Liver Transplantation: The INTEGRIS Experience
April Merrill, RN, BSN, BC, EDIBA Diabetes Center of Excellence, INTEGRIS Baptist Medical Center - EDIBA Diabetes Center of Excellence, Oklahoma City, OK, USA and Rise' Kester, MS, APRN, CNS, ediba Diabetes Center of Excellence, INTEGRIS Baptist Medical Center, Oklahoma City, OK, USA.
| Learning Objective #1: 1.The learner will be able to identify New Onset Diabetes Mellitus (NODM) after liver transplant. |
| Learning Objective #2: 2.The learner will be able to identify one method of glycemic management after liver transplant. |
Currently 17,491 individuals are on a list waiting for a new liver – some already have diabetes and many more will develop it following transplantation. New Onset Diabetes Mellitus (NODM) affects 9-21% of all liver transplant patients (LTP). With diabetes reaching epidemic proportions, it is imperative to provide proper hyperglycemic management in the LTP population. Tight glycemic control (TGC) in the ICU has already been proven to decrease length of stay, decrease risk of infection, and decrease mortality in cardiovascular surgery patients, its impact on LTP has yet to be established. Of the 747 liver transplants performed in
Oklahoma since 1998, 720 of these were done at
INTEGRIS Baptist Medical Center. For the last 2 years the Nazih Zudhi liver transplant surgeons and intensivists have teamed up with the diabetes nurse specialist to closely monitor and manage hyperglycemia in LTP. Nearly all LTP are started on an insulin infusion immediately post-op for glycemic control (Transplant ICU goal 80-110mg/dl). Post operative LTP are then transitioned from insulin infusions to a subcutaneous insulin protocol and then oral agents whenever possible. Patients requiring insulin prior to transplant will remain on insulin at discharge. Patients who did not previously require insulin therapy are managed according to: prior history of diabetes, corticosteroid dosage, immunosuppressant therapy, presence of Hepatitis C virus, and response to hyperglycemic therapy. LTP discharge planning includes education related to new antidiabetic medications, monitoring blood glucose levels, and insulin administration if needed. Patients then follow up with the Nazih Zudhi liver clinic and ediba Diabetes Center of Excellence. The INTEGRIS Baptist experience related to the impact of TGC in the LTP population will be presented.