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Hospital Intensive Insulin Program (HIIP)


Director: Roma Gianchandani, M.D.

The Hospital Intensive Insulin Program (HIIP) is an intensive insulin protocol program specially developed for the management of our diabetic/hyperglycemic inpatients at the University Hospital. Roma Gianchandani, M.D., Assistant Professor in the MEND Division, created the program, and manages it along with a team of doctors, a nurse practitioner, and physician assistants.

The importance of intensive diabetes control in the outpatient setting is now undisputed, and there are similar data from several inpatient intensive care settings.

Hyperglycemia in critically ill patients is an important correctable risk factor for inpatient morbidity and mortality. Data supporting the use of an insulin infusion to correct hyperglycemia are available from the cardiothoracic surgery, cardiology and critical care literature.

After major surgical procedures and in critical medical illnesses, patients (both diabetic and nondiabetic) develop hyperglycemia as a result of stress-induced insulin resistence. The major cause of hyperglycemia is the release of counterregulatory stress hormones (namely cortisol, growth hormone, catecholamines and glucagon) and local tissue cytokines. Excessive nutritional support, sepsis, hypothermia, hypoxemia, uremia and cirrhosis further reduce insulin production or worsen insulin resistence.

The hospitalized diabetic patient has a 3- to 4-fold higher complication rate due to various metabolic and immunological alterations caused by high blood sugars. Several studies demonstrate an improvement in morbidity and mortality when hyperglycemia is managed with an intensive insulin regimen post-cardiothoracic surgery, myocardial infarction and other intensive care settings. Based on this data, several major surgery and bypass programs have adopted intensive insulin management as standard of care with improved clinical outcomes.


U-M Pharmacy Guidelines for Diabetes Medication Use


The HIIP Medical Team


Roma Gianchandani, MD

roma gianchandani md

Tina Zrull, PA-C

tina zrull

Elizabeth DuBois, PA-C

elizabeth dubois

Nicole Desbrough, NP

nicole desbrough

Yan Qu, PA-C