Management of critically ill patients with diabetes

Abstract

Disorders of glucose homeostasis, such as stress-induced hypoglycemia and hyperglycemia, are common complications in patients in the intensive care unit. Patients with preexisting diabetes mellitus (DM) are more susceptible to hyperglycemia, as well as a higher risk from glucose overcorrection, that may results in severe hypoglycemia. In critically ill patients with DM, it is recommended to maintain a blood glucose range between 140-180 mg/dL. In neurological patients and surgical patients, tighter glycemic control (i.e., 110-140 mg/d) is recommended if hypoglycemia can be properly avoided. There is limited evidence that shows that critically ill diabetic patients with a glycosylated hemoglobin levels above 7% may benefit from looser glycemic control, in order to reduce the risk of hypoglycemia and significant glycemic variability.

Cenário ambulatorial de pacientes com sítio cirúrgico infectado após intervenção cardíaca

“…Stress-induced hyperglycemia and high post-surgery rates of glycated hemoglobin, even among patients with no previous diagnostic of this disease, contribute to increase the number of infections, leading to a worst prognosis and to an increase in cardiovascular morbi-mortality, making an adequate glycemic control essential. The same is true for smoking, which is, even in isolation, associated to SSI development (14,17) . Similarly, other authors reiterate that obesity and smoking are important predictors of complications, making worst clinical outcomes more likely in the short and long terms, and being determinant in pulmonary complications.…”

“…This study considered as mediastinitis cases of profound SW infections, with clinical and/or micro-biological evidences of retrosternal involvement, associated to sternum osteomyelitis, with or without instability (14) .…”

Glucose as an additional parameter to National Early Warning Score (NEWS) in prehospital setting enhances identification of patients at risk of death: an observational cohort study

“…Imbalanced diabetes causes chronic blood glucose disturbances, which may cause greater blood glucose variability. This patient group is also at higher risk of developing stress-induced blood glucose disturbances and risk of death due their underlying chronic condition 23. We did not separate diabetics and non-diabetics in the study as we wanted to study the usefulness of plasma glucose values as an additional parameter to NEWS in screening a mixed EMS population, so diabetes status was not on our focus in this study design.…”

Relação entre o estado nutricional, nutrição precoce, hiperglicemia e desfecho clínico de pacientes internados em uma unidade de terapia intensiva

“…E o manejo da hiperglicemia merece atenção especial na terapia do cuidado do paciente. 12 Podemos atribuir a baixa prevalência de hiperglicemia ao fato de não ser uma amostra composta por diabéticos, por uma adequada prescrição da TN a partir da avaliação nutricional, além de uma apropriada aplicação do protocolo de insulina instituído no hospital e também na possibilidade de o atendimento não ser feito na fase aguda, quando o estresse metabólico está acentuado. O estudo de Umpierrez et al (2002), ao avaliar 2030 pacientes adultos em um hospital de ensino comunitário no centro de Atlanta observou que a hiperglicemia esteve presente em 38% dos pacientes internados no hospital, dos quais 26% tinham história conhecida de DM e 12% não tinham história de DM antes da admissão.…”