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CS31
Impact of a Tight Control Insulin Protocol
By N. Roderman, G. Patel, & J. Farmer; Medical Center of Plano, Plano, TX
For further information, please contact: Nicki.Roderman@hcahealthcare.com
Purpose: The project was initiated to determine what impact a tight control insulin protocol would have on the average blood sugar of patients admitted to the intensive care unit.
Description: The impact of hyperglycemia in medical and surgical patients in the intensive care unit is well documented in the literature. The incidence of infection, sepsis, cardiovascular abnormalities, neuronal injury, and mortality are all greater when hyperglycemia is present. Although the benefits of euglycemia with a tight control insulin protocol are well-known, it is not known whether these patients are subjected to significant episodes of hypoglycemia. A tight control insulin protocol was developed and approved by all relevant hospital committees after determining that the average blood sugar with the current tight control protocol was 151 mg/dL. The new protocol called for a target blood sugar of 81-110 mg/dL with an insulin continuous infusion. The nursing staff was educated on the titration mechanics and calculations. Monitoring parameters included number of patients who acheived target blood glucose and number of episodes of hypoglycemia.
Evaluation/Outcomes: Patients blood sugars on the new tight control protocol were closely monitored from initiation of the insulin drip for up to three days. All patients monitored (18), except for one, were maintained within the targeted blood glucose range of 81-110 mg/dL. Episodes of hypoglycemia, defined as a blood glucose of less than 60 mg/dL, were infrequent. Of 1,031 blood glucoses measured, only 34 (3%) were below 60 mg/dL. A tight control insulin protocol in the intensive care unit allowed for patients to achieve and maintain euglycemia without subjecting them to significant hypoglycemia. Hypoglycemia has been perceived as a roadblock to initiating a tight control insulin program. The authors believe that with proper education, the clinical benefits of euglycemia can be reaped without hypoglycemia being an issue.
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