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506 Hyperglycemia & Glycemic Control In ICU

Glycemic management in ICU • Insulin of choice – Regular/Aspart
• Root of choice – IV continuous Insulin Adminis-
HYPOGLYCEMIA tration (Blood Sugar Above 200 with or without
All insulin infusion protocols, no matter how well Ketosis)
executed, almost always lead to some increase in
hypoglycemic events.Hypoglycemia is a potential • Below 200mg/dl intermittent sc insulin
complication of insulin therapy.It is defined as ei- • Once Blood Sugar is below 180 can be switched
ther moderate (blood glucose < 70mg/dL) or severe to sc or Basal insulin
(blood glucose < 40mg/dL) and is associated with
adverse outcomes. • Avoid large Excursions in Blood Sugar – Glycemic
variablity
HIGH RISKCASES • Avoid hypoglycemia below 80mg/dl
• Patients receiving bicarbonate-based fluid during • Correct infections strictly
CVVHD- Prolonged Insulin clearance
• Treat the underlying medical & surgical condition
• Hemodynamically unstable patients in need of effectively
inotropic support- as hypoglycemia is associated
with shock CONCLUSION:-
• Women- Lower counterregulatory threshold • Hyperglycemia in ICU is never Benign
• patients with known diabetes • Surgical ICU including CABG stringent glucose
control, Fasting glucose <110mg/dl
• Septic patients
• Patients with interruptions in or intolerance to nu- • Medical ICU good control . Glucose 140-180mg/dl
tritional support. • IV Rapid acting Insulin is the choice
• Glycemic management in ICU • Avoid Glycemic variability

• Avoid Hypoglycemia
Recommendations:
• Based on the best available evidence, an approach • Development of Institution specific Insulin protocol
targeting a moderate BG value between 140 and is essential
180 mg/dL, as endorsed by the American Asso-
ciation of Clinical References:
1. Umpierrez GE, Isaacs SD, Bazargan N, et al. Hyperglycemia: an inde-
• Endocrinologists and the American Diabetes As- pendent marker of in-hospital mortality in patients with undiagnosed
sociation, seems most prudent diabetes. J Clin Endocrinol Metab. 2002;87(3):978-982.

• Wide fluctuations in glucose values should also 2. ACE- Endocrine Practice 10 (1): 77-82, 2004 ;ADA- Diabetes Care 27:
be avoided, given increasing data pointing to the 553-591, 2004
detrimental effects of glycemic variability 3. Elisabeth Donahey, et al Management of Hyperglycemia in Critically Ill
Patients Pharmacy Practice News November 2013
• Hyperglycemia in critically ill patients whether dia- 4. Rady et al. Mayo Clin Proc 2005;80:1558–67 Ainla et al. Diabet Med
betic or not should be addressed properly. Insulin 2005;22:1321–5
therapy should be proactive, with frequent adjust-
ments to optimize control; 5. Tumul Chowdhury General intensive care for patients with traumatic
audi J Anaesth. 2014 Apr-Jun; 8(2): 256–
brain injury: An update S
• One should avoid the twin dangers of hypogly- 263. doi: 10.4103/1658-354X.130742.
caemia and uncontrolled hyperglycaemia both of 6. Van den Berghe et al. N Engl J Med. 2001;345:1359-1367.
which can have harmful and possibly fatal conse-
quences.
• Target Blood Glucose : below 180mg/Dl

• Fasting below: Blood glucose level in ICU patients
should be maintained below 110 mg/dl (fasting)
• Target Blood Sugar PP-180mg/dl

• Target Blood Sugar Fasting – 110mg.dl

GCDC 2017