The Ministry of Health and Family Welfare (MoHFW) has issued Clinical Guidance on Diabetes Management at COVID-19 Patient Management Facility on 26th Agust 2020.
At the outset, it highlights the following two important points:
- Every patient must be screened at admission for hyperglycemia with at least two capillary blood glucose values (1 pre-meal and 1 post-meal value) by a glucometer.
- Every patient with diabetes should be started on a diabetic diet. The patient must strictly adhere to the timing and quantity advised in the diet chart.
The broad aspects of the Guidance Note are as follows:
- Section 1: Screening of hyperglycemia in every patient hospitalized with COVID-19 (at admission and on starting steroids)
All newly admitted patients must be evaluated for diabetes/hyperglycemia. This section provides a comprehensive chart detailing the screening requirement.
- Section 2: Oral antihyperglycemic drugs (OAD)
This section stipulates for the treatment of patients with known diabetes who are on OAD at admission. It also mandates the initiation of OAD in patients newly detected to have diabetes at admission. The section provides for treatment in both these scenarios.
- Section 3: Basal-bolus insulin regimen
This section covers the initiation of insulin for patients newly detected with diabetes and states the recommended dosage. It provides a procedure to be followed if the patient is on OAD and blood glucose levels are uncontrolled. It states that if the patient is already on basal-bolus insulin regimen at admission, the existing regimen may be continued. In such cases, the blood glucose levels must be monitored and they may be reviewed with the BG log to an endocrinologist/ physician.
The section also specifies the criteria for switching to basal-bolus insulin regimen from insulin infusion. It furthers lays down directions for cases where the patient is on Ryles Tube (RT) feeds. It also specifies the guidelines for titration of insulin doses and glycemic targets.
It additionally depicts a Capillary BG monitoring chart that must be maintained for every patient.
- Section 4: Intravenous insulin infusion
This section covers the indications for the use of intravenous insulin infusion. The section also deals, amongst others, with procedures for infusion preparation and frequency of blood glucose monitoring.
- Section 5: Clinical Guidance on Anti-hyperglycemic Treatment Initiation and Titration in Patients with COVID-19 and Diabetes
This section tables different scenarios, the corresponding BG levels and the action to be taken in each instance.
