HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) All Versions of this Article: dc06-1964v1 30/4/1005    most recent Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Wilson, M. Articles by Hoo, G. W. S. Search for Related Content PubMed PubMed Citation Articles by Wilson, M. Articles by Hoo, G. W. S. Social Bookmarking                What's this?

Intensive Insulin Therapy in Critical Care

A review of 12 protocols

¹ Endocrine Section, West Los Angeles Healthcare Center, VA Greater Los Angeles Healthcare System, David Geffen School of Medicine at UCLA, Los Angeles, California
² Pulmonary and Critical Care Section, West Los Angeles Healthcare Center, VA Greater Los Angeles Healthcare System, David Geffen School of Medicine at UCLA, Los Angeles, California

Address correspondence and reprint requests to Guy W. Soo Hoo, MD, MPH, Pulmonary and Critical Care Section (111Q), West Los Angeles Healthcare Center, 11301 Wilshire Blvd., Los Angeles, CA 90073. E-mail: guy.soohoo{at}med.va.gov

OBJECTIVE—To review performance characteristics of 12 insulin infusion protocols.

RESEARCH DESIGN AND METHODS—We systematically identify and compare 12 protocols and then apply the protocols to generate insulin recommendations in the management of a patient with hyperglycemia. The main focus involves a comparison of insulin doses and patterns of insulin administration.

RESULTS—There is great variability in protocols. Areas of variation include differences in initiation and titration of insulin, use of bolus dosing, requirements for calculation in adjustment of the insulin infusion, and method of insulin protocol adjustments. Insulin recommendations for a sample patient are calculated to highlight differences between protocols, including the patterns and ranges of insulin dose recommended (range 27–115 units [mean ± SD 66.7 ± 27.9]), amount recommended for glucose readings >200 mg/dl, and adjustments nearing target glucose.

CONCLUSIONS—The lack of consensus in the delivery of intravenous insulin infusions is reflected in the wide variability of practice noted in this survey. This mandates close attention to the choice of a protocol. One protocol may not suffice for all patients.

Abbreviations: AACE, American Association of Clinical Endocrinologists • ADA, American Diabetes Association • ICU, intensive care unit • MICU, medical ICU

CiteULike    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

				N. J. D'Hondt Continuous Intravenous Insulin: Ready for Prime Time Diabetes Spectr, October 1, 2008; 21(4): 255 - 261. [Abstract] [Full Text] [PDF]

				F. M. Brunkhorst, C. Engel, F. Bloos, A. Meier-Hellmann, M. Ragaller, N. Weiler, O. Moerer, M. Gruendling, M. Oppert, S. Grond, et al. Intensive Insulin Therapy and Pentastarch Resuscitation in Severe Sepsis N. Engl. J. Med., January 10, 2008; 358(2): 125 - 139. [Abstract] [Full Text] [PDF]

				G. Thomas, M. C. Rojas, S. K. Epstein, E. M. Balk, O. Liangos, and B. L. Jaber Insulin therapy and acute kidney injury in critically ill patients a systematic review Nephrol. Dial. Transplant., October 1, 2007; 22(10): 2849 - 2855. [Abstract] [Full Text] [PDF]