The Effect of a Hypoglycemia Treatment Protocol on Glycemic Variability in Critically Ill Patients

Arnold, Patrick; Paxton, Renee; McNorton, Kelly; Szpunar, Susan; Edwin, Stephanie B.

doi:10.1177/0885066613511048

Cited by 15 publications

(6 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Patient factors such as age, sex, use of D10% after initiation of D40%, time to recheck blood glucose, use of insulin, insulin secretagogue, other OAD, CKD, liver disease, and status of recurrent hypoglycaemia were found to have minimal impact to blood sugar response. This finding was in an agreement with previous study by Arnold et al 15 Non-significant differences in post-correction blood sugar response from administration of D40% iv bolus and infusion in this study can be caused by the small number of samples. The preference for using D40% concentrated solution for the management of hypoglycaemia at this time is by iv infusion for 15 minutes until proven through further research.…”

Section: Discussionsupporting

confidence: 94%

Comparison of Effects of The Hypoglycemia Management Protocol with 40% Dextrose Concentrated Solution to the Post-Correction Blood Sugar Response through Intravenous Infusion and Intravenous Bolus

Yuriani

Andrajati

Pramono

2019

ijcp

View full text Add to dashboard Cite

Hypoglycemic patients who receive 40% dextrose (D40%) concentrated solution in the correction process need to avoid excessive blood glucose spikes. Administration of D40% was found in two different ways, through intravenous infusion (iv infusion) and intravenous bolus (iv bolus) and the effects of both types of administration were unknown. The purpose of this study was to compare the effect of a hypoglycemia treatment protocol using D40% concentrated solution to the post-correction blood sugar response through iv infusion and iv bolus at two different hospitals with two distinct protocols. This comparative analytical cross-sectional study was conducted retrospectively at St. Carolus Hospital (D40% iv infusion group) and Bella Hospital (D40% iv bolus group). Blood glucose responses, in form of coefficient of variation and degree of overcorrection, were compared between groups. The overall median blood glucose response was 69.5 (3–195) mg/dL for iv infusion group (n=60) and 77 (15–249) mg/dL for iv bolus group (n=62) (p=0.259). The coefficient of variation with iv infusion and iv bolus group were 47.18% and 52.75%, respectively. The median of degree of overcorrection in iv infusion group was lower compared with iv bolus group, 10% (0–138%) versus 23% (0–195%), respectively. Both D40% protocols did not have a significant correlation with the degree of overcorrection (Mann-Whitney test; p=0.099). D40% iv infusion and bolus administration had no effect to the post-correction blood sugar response.Keywords: Blood glucose, dextrose 40%, hypoglycemia, intravenous bolus, intravenous infusion Perbandingan Efek Protokol Manajemen Hipoglikemia dengan Larutan Pekat Dekstrosa 40% secara Intravena Infus dan Intravena Bolus terhadap Respon Gula Darah PascakoreksiAbstrakPasien hipoglikemia yang menerima larutan pekat dekstrosa 40% (D40%) dalam proses koreksinya perlu menghindari lonjakan gula darah yang berlebih. Cara pemberian D40% diberikan dengan dua cara yang berbeda yaitu melalui intravena infus (iv infus) dan intravena bolus (iv bolus), dan efek dari kedua jenis pemberian tersebut belum diketahui. Tujuan dari penelitian ini adalah membandingkan efek protokol manajemen hipoglikemia dengan larutan pekat D40% secara iv infus dan iv bolus terhadap respon gula darah pascakoreksi di dua rumah sakit dengan protokol yang berbeda. Penelitian analitik komparatif secara potong lintang ini dilakukan secara retrospektif di RS St. Carolus (kelompok iv infus D40%) dan RS Bella (kelompok iv bolus D40%). Respon gula darah, dalam bentuk koefisien variasi dan derajat overkoreksi, dibandingkan antara kedua kelompok. Median kenaikan gula darah pada kelompok iv infus D40% 69,5 (3–195) mg/dL (n=60 pasien) dan kelompok iv bolus D40% 77 (15–249) mg/dL (n=62 pasien) (p=0,259). Koefisien variasi dengan iv infus adalah 47,18% dan iv bolus 52,75%. Median derajat overkoreksi iv infus D40% lebih rendah dibandingkan iv bolus D40%, dengan masing-masing 10% (0–138%) dan 23% (0–195%). Kedua cara pemberian D40% tidak memiliki hubungan yang bermakna dengan derajat overkoreksi (uji Mann-Whitney; p=0,099). Pemberian iv infus dan bolus D40% tidak memiliki pengaruh terhadap respon gula darah pascakoreksi.Kata kunci: Dekstrosa 40%, gula darah, hipoglikemia, intravena bolus, intravena infus

show abstract

Section: Discussionsupporting

confidence: 94%

Comparison of Effects of The Hypoglycemia Management Protocol with 40% Dextrose Concentrated Solution to the Post-Correction Blood Sugar Response through Intravenous Infusion and Intravenous Bolus

Yuriani

Andrajati

Pramono

2019

ijcp

View full text Add to dashboard Cite

show abstract

“…[14][15][16] All meta-analyses and systematic reviews conclude that TGC does not reduce mortality, but increases the incidence of hypoglycemia strongly. 17,18 Insulin-induced hypoglycemia may thus be the culprit in mitigating the benefits of TGC.…”

Section: Blood Glucose Control: the Clinical Trialsmentioning

confidence: 99%

Accuracy of Blood Glucose Measurement and Blood Glucose Targets

Eerdekens

Rex

Mesotten³

2020

J Diabetes Sci Technol

View full text Add to dashboard Cite

Background: To summarize new evidence regarding the methodological aspects of blood glucose control in the intensive care unit (ICU). Methods: We reviewed the literature on blood glucose control in the ICU up to August 2019 through Ovid Medline and Pubmed. Results: Since the publication of the Leuven studies, the benefits of glycemic control have been recognized. However, the methodology of blood glucose control, notably the blood glucose measurement accuracy and the insulin titration protocol, plays an important but underestimated role. This may partially explain the negative results of the large, pragmatic multicenter trials and made everyone realize that tight glycemic control with less-frequent glucose measurements on less accurate blood glucose meters is neither feasible nor advisable in daily practice. Blood gas analyzers remain the gold standard. New generation point-of-care blood glucose meters may be an alternative when using whole blood of critically ill patients in combination with a clinically validated insulin dosing algorithm. Conclusion: When implementing blood glucose management in an ICU one needs to take into account the interaction between aimed glycemic target and blood glucose measurement methodology.

show abstract

“…38 While the concept of iatrogenic GV-a product of overcorrection of BG levels upon administration of dextrose to correct episodes of hypoglycemia-has been brought up in the past, newer protocols have been described to minimize GV while allowing for appropriate management of hypoglycemia in critical illness. 39 Mechanistically, in vitro studies have linked marked fluctuations in BG level with increase in oxidative stress and downstream endothelial dysfunction and cellular apoptosis. 40,41 Additional in vivo studies have also shown that glucose variability exerts a stronger influence as a cause of oxidative stress compared with sustained hyperglycemia.…”

Section: Glycemic Variabilitymentioning

confidence: 99%

The Long and Winding Road to Personalized Glycemic Control in the Intensive Care Unit

Tickoo

2019

Semin Respir Crit Care Med

View full text Add to dashboard Cite

In the critically ill adult, dysglycemia is a marker of disease severity and is associated with worse clinical outcomes. Close monitoring of glucose and use of insulin in critically ill patients have been done for more than 2 decades, but the appropriate target glycemic range in critically ill patients remains controversial. Physiological stress response, levels of inflammatory cytokines, nutritional intake, and level of mobility affect glycemic control, and a more personalized approach to patients with dysglycemia is warranted in critically ill intensive care unit (ICU) patients. We discuss the pathophysiology and downstream effects of altered glycemic response in critical illness, management of glycemic control in the ICU, and future strategies toward personalization of critical care glycemic management.

show abstract

The Effect of a Hypoglycemia Treatment Protocol on Glycemic Variability in Critically Ill Patients

Abstract: Implementation of the hypoglycemia treatment protocol described led to a reduction in glucose variability, while still providing a safe and effective way to manage hypoglycemia in critically ill patients.

Cited by 15 publications

References 20 publications

Comparison of Effects of The Hypoglycemia Management Protocol with 40% Dextrose Concentrated Solution to the Post-Correction Blood Sugar Response through Intravenous Infusion and Intravenous Bolus

Comparison of Effects of The Hypoglycemia Management Protocol with 40% Dextrose Concentrated Solution to the Post-Correction Blood Sugar Response through Intravenous Infusion and Intravenous Bolus

Accuracy of Blood Glucose Measurement and Blood Glucose Targets

The Long and Winding Road to Personalized Glycemic Control in the Intensive Care Unit

Contact Info

Product

Resources

About