Approaches & Tools
Management of Hyperglycemia in the ICU Setting
Management of Hyperglycemia in the ICU Setting
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In this section you will find:
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Slide Presentation – summarizing the available published intravenous insulin protocols and discussing the ideal candidates for intravenous insulin as well as guidelines for transitioning a patient from intravenous to subcutaneous regimens
- Intravenous insulin protocols – Examples of published intravenous insulin protocols that have been demonstrated to be safe and efficacious; please note that many protocols are being re-worked in line with modified treatment goals
- Reference list – and suggested Key Readings
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Selected full text publications and abstracts
Key Points:
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Intravenous insulin is the easiest and most precise way to achieve tight blood glucose control in this setting
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A simple order to “titrate to a blood glucose of 180 mg/dl” is no longer sufficient. Even the most experienced ICU nurse will find it a challenge to properly titrate IV insulin to maintain euglycemia without specific and precise guidelines
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Successful implementation of protocols requires:
- Buy-in from key stakeholders (eg, critical care physicians, house staff, nursing, pharmacy, hospital administration, etc.)
- Appropriate education through in-servicing of hospital staff
- Ongoing monitoring of results
- Support from endocrinologists for specific questions or when a patient does not respond to the protocol as expected
Finally:
It is important to keep in mind that these algorithms have never been directly compared in clinical trials. Therefore, in selecting a protocol, one should look for characteristics that are compatible with the institution in which it will be implemented. Consideration should be given to factors such as whether or not the protocol is “dynamic” (ie, allows for variability in insulin requirements and accounts for rates of change in blood glucose concentrations; its user-friendliness/complexity; the need to perform basic calculations; and the suitability for various local computer systems). None of the examples provided are suitable for the treatment of diabetic ketoacidosis. Lastly, because some patients in the intensive care unit may receive subcutaneous insulin, please see the section on the “Inpatient Non ICU” for specific subcutaneous insulin protocols.
