[epicproviders] IMPORTANT Glucommander Reminders: Updates as of 6/6/2023

[Epic - All Provider Staff]

Inpatient & Emergency Department Providers
**Excludes Peds & OB**

Glucommander Go Live Reminders:

  *   Glucommander Lantus Order
     *   Glucommander requires the Glucommander specific Lantus order to initiate a patient in Glucommander. To ensure the appropriate orders are placed, follow the steps below:
1. Discontinue all previous hypoglycemic treatments, Lispro and Lantus orders.
2. Discontinue all non-insulin anti-diabetic medication.
3. Place Initiate Glucommander SubQ Order Set
4. Review Due time of the Lantus dosing (change to appropriate time based on previous Lantus dose).
                Important: Ensure patients with Type 1 Diabetes do not go without basal insulin.


  *   Candidates for Glucommander SubQ
     *   Patient requires insulin therapy (basal/bolus) but an IV insulin infusion isn't indicated.
     *   Patient has Type 1 Diabetes.
     *   Patient has Type 2 Diabetes on insulin prior to admission.
     *   Patient has Type 2 Diabetes, not on insulin prior to admission, but has persistent hyperglycemia > 180 mg/dL.
     *   Patient with no history of diabetes with persistent hyperglycemia > 180 mg/dL (e.g., stress or steroid-induced).
Note: All other Insulin orders should be discontinued and no other insulin orders placed.


  *   Not a Candidate for Glucommander SubQ
     *   Patients who do not require Inpatient Basal insulin.
     *   On continuous TPN/TF + bolus TF.
     *   Eating more than 3 meals + bedtime snack.
     *   On concentrated insulins during hospitalization.
     *   On premixed insulins during hospitalization.
     *   On insulin pumps during hospitalization.
     *   Declining BG checks or insulin management.
     *   Unstable, critically ill (use Glucommander IV).
Precautions:

     *   Not commonly recommended to continue non-insulin diabetes agents in the hospital setting.
        *   Continuing these agents may increase the patient's risk of hypoglycemia.

To learn more about the Glucommander SubQ provider workflows, click here<https://www.upstate.edu/ihospital/intra/glucommander/glucommander-sq.php>.


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