Intensive Insulin Therapy in Critical Care
A review of 12 protocols
- Mark Wilson, MD1,
- Jane Weinreb, MD1 and
- Guy W. Soo Hoo, MD, MPH2
- 1Endocrine Section, West Los Angeles Healthcare Center, VA Greater Los Angeles Healthcare System, David Geffen School of Medicine at UCLA, Los Angeles, California
- 2Pulmonary 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
Abstract
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.
- AACE, American Association of Clinical Endocrinologists
- ADA, American Diabetes Association
- ICU, intensive care unit
- MICU, medical ICU
Footnotes
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Published ahead of print at http://care.diabetesjournals.org on 9 January 2007. DOI: 10.2337/dc06-1964.
M.W. has received consulting fees from Sanofi-Aventis. J.W. has received honoraria from Sanofi-Aventis and Novartis.
A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.
The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C Section 1734 solely to indicate this fact.
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- Accepted January 2, 2007.
- Received September 20, 2006.
- DIABETES CARE
