Hypoglycemic Events in Intensive Care Patients: Analysis by Insulin Administration Method and Sample Type

Abstract

Background Intensive insulin treatment is associated with an increased risk of hypoglycemia, so strict glycemic monitoring is essential. The best type of sample for identifying hypoglycemia remains under debate. Objectives To establish the number of hypoglycemic events in intensive care patients relative to insulin administration method and the method used to collect the blood sample. Methods Retrospective descriptive study lasting 6 months. Hypoglycemia was defined as a blood glucose level less than 80 mg/dL (mild: 50-79 mg/dL, severe: <50 mg/dL), measured with a bedside glucometer and blood from the arterial catheter or fingerstick, in critically ill patients who require insulin administered subcutaneously (with sliding scales) or via continuous intravenous perfusion (intense infusion protocol with a nurse-managed insulin therapy algorithm). Results Analysis of the 6636 samples from 144 critically ill patients revealed 188 mildly hypoglycemic samples (2.8%) and 3 severely hypoglycemic samples (0.04%). The prevalence of mild hypoglycemia was greater when insulin was administered intravenously (3.2%) rather than subcutaneously (2.3%; P = .04). Among patients receiving insulin intravenously, hypoglycemia was found more often in arterial (4.5%) than in capillary (2.8%) blood (P = .01). The prevalence of hypoglycemia in capillary blood samples did not differ significantly between subcutaneous (2.3%) and intravenous (2.8%) insulin therapies (P = .21). Conclusions With a target blood glucose level of 110 to 140 mg/dL, few hypoglycemic events are detected in critically ill patients, regardless of whether insulin is administered intravenously or subcutaneously. Analysis of solely arterial samples may yield a higher prevalence of hypoglycemia than otherwise.

Hyperglycemia Control of theNil Per OsPatient in the Intensive Care Unit: Introduction of a Simple Subcutaneous Insulin Algorithm

“…[8][9][10][11] Nevertheless, the American Association of Clinical Endocrinologists and American Diabetes Association consensus statement on inpatient glycemic control 12 suggests that IVI infusion is the preferred route of insulin administration in critically ill patients, though a few studies indicate that subcutaneous (SQ) insulin protocols using rapidacting analogs may be equally efficacious and result in less hypoglycemia. [13][14][15] Furthermore, from the nursing perspective, IVI protocols are labor intensive. It is estimated that 2-3 h per day of direct nursing time is required for hourly glucose monitoring and IVI adjustments, 16,17 and insulin infusion protocols can be viewed as too complex by even experienced nurses.…”

Glycemic control in patients receiving insulin critics: integrative review

“…7 Research described the conventional glycemic control with insulin SC applied to cardiothoracic surgery patients. Acute postoperative hyperglycemia and its immediate correction with intravenous insulin were associated with good results for critical patients.…”

“…The use of subcutaneous (SC) and intravenous insulin (IV) on glycemic control (n=7) [7][8][9][10][11][12][13][14] The study established the number of hypoglycemic events related to critical patients in relation to the administration of IV insulin and SC insulin in the treatment of hyperglycemia.…”