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RES207
The Pendulum Swings Back To Hyperglycemia When Intravenous Insulin Infusions Are Discontinued
By: F.Y. Li, M.E. Lough, &G.K. Chan.; Stanford Hospital & Clinics, CA
For further information, please contact: FLI@stanfordmed.org
Purpose: The purposes of this study were to describe transition methods used to discontinue an intensive intravenous (IV) insulin protocol, and to observe post-protocol blood glucose (BG) management.
Background/Significance: BG control between 80-110 mg/dl with an IV insulin protocol reduces morbidity and mortality in intensive care unit (ICU) patients. Methods to transition off the IV insulin infusion, and BG management in the 24 hours post-protocol have not been studied.
Methods: A retrospective chart review of 30 adult ICU patients on an intensive IV insulin protocol was conducted. Exclusion criteria: type 1 diabetes mellitus (DM), total pancreatectomy, diabetic ketoacidosis, hyperglycemic hyperosmolar state, end of life care, and total parental nutrition (TPN) with insulin in TPN bag. Data were collected on BG levels and insulin dosage before, during, and after the protocol. Precision PCx or i-Stat (Abbott) glucometers were used. Insulin dosage over the last 4 hours of the protocol was used to calculate a predictive adjusted daily insulin dose for the 24 hours post-protocol. Descriptive statistics and intraclass correlation coefficient were used to analyze data.
Results: 30 patients (12 M, 18 F); mean age 58 y (SD=14); mean APACHE II score 23 (SD=10); mean ICU length of stay 9 d (SD=9); 70% had type 2 DM. Mean BG (mg/dl): pre-protocol 241 (SD=77); last 24 h on protocol 109 (SD=31); 24 h post-protocol 181 (SD=70). To transition off: 13% (n=4) received NPH; 83% (n=25) no transition insulin. In the 24 h post-protocol: 83% (n=25) received regular insulin scale; 17% (n=5) a short and long-acting insulin regimen; 7% (n=2) oral hypoglycemic agent; 13% (n=4) no treatment; the total insulin administered averaged 15 units (SD=16). The adjusted daily insulin dose averaged 58 units (SD=29). A low intraclass correlation coefficient (ICC = 0.09) reflects this difference.
Conclusions: BG control in a target range of 80-110 mg/dl is achievable with an intensive IV insulin protocol in the ICU, but hyperglycemia quickly recurs without a standardized transition method and post-protocol plan to provide adequate insulin coverage.
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