Upcoming changes to inpatient consistent carbohydrate diet orders
Intermountain Health is implementing updated standards for inpatient consistent carbohydrate diet orders to support improved blood glucose management for patients with diabetes or hyperglycemia while hospitalized.
Key changes include:
Standardizing the default diet order to 60 grams of carbohydrate per meal (consistent with ADA guidelines recommending to start at ~45-60g carb/meal). No default existed prior to this updated standard.
Limiting snacks between meals to 0-5 grams of carbohydrates for patients on this diet to provide additional nutrition options while also better supporting basal bolus insulin dosing in the hospital.
Providing patients with an expanded menu with approved snack options.
No longer offering regular juice and regular soda as a beverage choice on a carb consistent diet order.
Utilizing dietitian consultation for patients who require higher carbohydrate limits or if any questions or concerns arise related to a patient’s nutritional requirements.
Clinical rationale:
Carbohydrates raise blood glucose levels, and patients on a basal bolus insulin regimen require insulin whenever carbohydrates are consumed.
The updated standards are intended to better align carbohydrate intake with insulin administration in the hospital and support safer and more effective inpatient glucose management. The project team identified an opportunity to improve blood glucose management across the organization while recognizing that current staffing models do not support routine insulin administration for carbohydrate-containing snacks consumed between meals.
What you should do:
Use the default 60-gram consistent carbohydrate diet order (that will now be preselected) when clinically appropriate.
Consult an RDN when higher carbohydrate limits may be needed.
Reinforce the clinical rationale when discussing dietary restrictions with patients.
Anticipate questions from patients who have previously received broader snack options.
Review this Practice Change Update for more information.
Thank you for your partnership in supporting safe and effective blood glucose management for hospitalized patients.