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Table 82.4

Management of Hyperglycemia after Acute Coronary Syndrome (DIGAMI Regimen)

New diagnosis of DM or known DM with plasma glucose >10 mmol/L: *

  • Confirm initial capillary blood glucose levels with laboratory measurement; check also plasma potassium and HbA1c.
  • Start a variable-rate insulin infusion (Table 82.3).
  • Continue the variable-rate insulin infusion until there is stability of plasma glucose (target 4–10 mmol/L) and cardiovascular system, and the patient is able to eat and drink normally. At this point, change to SC insulin (see text).
  • While the patient is receiving IV insulin infusion, give glucose 5% IV at a rate of 500 mL 12-hourly. Add 40 mmol KCL to this solution, unless plasma potassium is >5.3 mmol/L.
Known DM and plasma glucose <10 mmol/L

Continue usual treatment and monitor plasma glucose pre-prandially and at 2200h. If plasma glucose rises >10 mmol/L, manage as above.

Current ESC guidance is to treat if the plasma glucose is >10 mmol/L although the DIGAMI trial used the threshold >11 mmol/L