Safety and efficacy of continuous insulin infusion in noncritical care settings

Smiley, Dawn; Rhee, Mary K.; Peng, Limin; Roediger, Laurian; Mulligan, Patrick; Satterwhite, Lewis; Bowen, Patrick

doi:10.1002/jhm.646

Cited by 38 publications

(32 citation statements)

References 28 publications

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“…However, the results suggest that other factors, such as diabetes status and oral intake added more variability than expected. Other studies report difficulty maintaining glycemic control in patients who are eating while receiving an insulin infusion (6,10). This may add further complexity to the calculation of basal insulin requirements from insulin infusions.…”

Section: Discussionmentioning

confidence: 99%

Comparison of 3 Algorithms for Basal Insulin in Transitioning from Intravenous to Subcutaneous Insulin in Stable Patients after Cardiothoracic Surgery

et al. 2011

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Objective The objective was to determine the efficacy of an algorithim containing aspart dosed according to carbohydrate intake and one of 3 initial doses of detemir in stable cardiac surgery patients requiring intravenous (IV) insulin. Methods Patients were extubated, off pressors and otherwise stable, requiring at least 1 unit/hr of IV insulin at least 48 hours following surgery. Subjects were randomized to once daily detemir at 50, 65, or 80% of IV basal insulin requirements and received aspart according to carbohydrate intake. The dose of detemir was adjusted daily over 72 hours. Results The number of patients with an initial morning glucose 80–130 mg/dl was 36, 63, and 56% of patients at the 50, 65, and 80% doses (p=0.12) (n=82). However, the mean overall glucose at 24 and 72 hours was similar between groups, and 86, 93, and 92% achieved a mean glucose 80–180 mg/dl at 72 hours (p=0.60). Hypoglycemia (<65 mg/dl) only occurred in the 65% (21%) and 80% (12%) groups over the first 72 hours (p=0.02 in the 50% compared to the 65 and 80% groups combined) with one event <40 mg/dl in the 80% group. There was no loss of glycemic control by the end of the once daily dosing interval. Conclusions Glycemic targets can be achieved without hypoglycemia by 72 hours in most cardiac surgery patients requiring IV insulin with a regimen containing an initial detemir dose of 50% of basal IV insulin requirements and prandial and supplemental insulin.

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Section: Discussionmentioning

confidence: 99%

Comparison of 3 Algorithms for Basal Insulin in Transitioning from Intravenous to Subcutaneous Insulin in Stable Patients after Cardiothoracic Surgery

et al. 2011

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“…53,96 For patients who are restricted to nothing by mouth or are receiving continuous enteral nutrition, POC testing is recommended every 4 to 6 hours. More frequent glucose monitoring is indicated in patients treated with continuous intravenous insulin infusion 103,104 or after a medication change that could alter glycemic control (eg, corticosteroid use or abrupt discontinuation of enteral or parenteral nutrition) 101,105,106 or in patients with frequent episodes of hypoglycemia. 11,53 …”

Section: Managing Hyperglycemia In the Hospital Environmentmentioning

confidence: 99%

Insulin Therapy for the Management of Hyperglycemia in Hospitalized Patients

McDonnell¹,

Umpiérrez²

2012

Endocrinology and Metabolism Clinics of North America

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It has long been established that hyperglycemia with or without a prior diagnosis of diabetes increases both mortality and disease-specific morbidity in hospitalized patients1–4 and that goal-directed insulin therapy can improve outcomes.5–9 During the past decade, since the widespread institutional adoption of intensified insulin protocols after the publication of a landmark trial,5,10 the pendulum in the inpatient diabetes literature has swung away from achieving intensive glucose control and toward more moderate and individualized glycemic targets.11,12 This change in clinical practice is the result of several factors, including challenges faced by hospitals to coordinate glycemic control across all levels of care,13,14 publication of negative prospective trials,15,16 revised recommendations from professional organizations,17,18 and increasing evidence on the deleterious effect of hypoglycemia.19–22 This article reviews the pathophysiology of hyperglycemia during illness, the mechanisms for increased complications and mortality due to hyperglycemia and hypoglycemia, beneficial mechanistic effects of insulin therapy and provides updated recommendations for the inpatient management of diabetes in the critical care setting and in the general medicine and surgical settings.23,24

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“…Even the most sophisticated insulin infusion algorithms are perturbed in patients who are eating, 115,116 likely representing the inability of standardized algorithms to adapt to the rapid glucose level changes induced by eating. In such patients, subcutaneous rapid-acting insulin may be provided to cover meals.…”

Section: Managementmentioning

confidence: 99%