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Cardio Diabetes Medicine 2017 497

Hyperglycemia & Glycemic Control in ICU

Prof. Dr. S. Arulrhaj MD.,FRCP (G)
Head, Acute Medicine

Dr.Aarathy Kannan, M.D.,
Physician & Diabetologist
Dr. Kiran Palsania & Dr.Bhuvaneshwar
Postgraduate in Internal Medicine, Sundaram Arulrhaj Hospitals, Tuticorin, India

INTRODUCTION Intensive glycemic control reduces morbidity and
mortality in critically ill patients, Hence hyperglycemia
Hyperglycemia is a common complication of critical
illness, regardless of a history of diabetes mellitus. In no longer benign in ICU.
many occasions Critically ill patients without Diabe-
tes can be hyperglycemic. It has an estimated prev- OVERVIEW
alence of approximately 40% in hospitalized patients. Hyperglycemia is exceedingly common in critical ill-
Initially, hyperglycemia was presumed to be an adap- ness and may be seen in virtually all adult medical
tive stress response that was beneficial to survival. ICU patients when the threshold blood glucose (BG)
The fight-or-flight response. value is set at >110 mg/dL. In an observational study,
ICU patients with newly diagnosed hyperglycemia
Hyperglycemia during acute illness is called stress
hyperglycemia had significantly higher mortality (31%) compared with
patients with known diabetes (10%) or normoglyce-
Stress hyperglycemia usually is defined as an in- mia (11.3%). Van den Berghe and coworkers in 2001
crease in blood glucose above 200 mg / dL in the directly addressed this question and demonstrated
presence of acute illness. that targeting strict euglycemia (80 to 110 mg/dL)
can lead to meaningful morbidity and mortality re-

RECOGNITION AND DIAGNOSIS OF HYPERGLYCEMIA AND DIABETES IN ICU SETTING

Upon admission: Assess all patients for a history of diabetes, Obtain laboratory blood glucose testing

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