Utilization of a Computerized Intravenous Insulin Infusion Program to Control Blood Glucose in the Intensive Care Unit

2007 ◽  
Vol 9 (3) ◽  
pp. 232-240 ◽  
Author(s):  
Rattan Juneja ◽  
Corbin Roudebush ◽  
Nilay Kumar ◽  
Angela Macy ◽  
Adam Golas ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Blood Glucose ◽  
Insulin Infusion ◽  
Control Blood Glucose ◽  
Intravenous Insulin

Treatment of Diabetic Ketoacidosis With Intravenous U-500 Insulin in a Patient With Rabson-Mendenhall Syndrome: A Case Report

2016 ◽  
Vol 30 (4) ◽  
pp. 468-475 ◽  
Author(s):  
Megan M. Moore ◽  
Abby M. Bailey ◽  
Alexander H. Flannery ◽  
Regan A. Baum
Keyword(s):  
Insulin Resistance ◽  
Case Report ◽  
Blood Glucose ◽  
Diabetic Ketoacidosis ◽  
Insulin Infusion ◽  
Genetic Disorder ◽  
Regular Insulin ◽  
Control Blood Glucose ◽  
Intravenous Insulin ◽  
High Doses

Rabson-Mendenhall syndrome is a rare genetic disorder resulting from mutations in the insulin receptor and is associated with high degrees of insulin resistance. These patients are prone to complications secondary to their hyperglycemia including diabetic ketoacidosis (DKA). We report the case of a 19-year-old male with Rabson-Mendenhall syndrome presenting with DKA who required doses of up to 500 U/h (10.6 U/kg/h) of insulin. The patient’s insulin infusion was originally compounded with U-100 regular insulin, although to minimize volume, the product was compounded with U-500 insulin. The DKA eventually resolved requiring infusion rates ranging from 400 to 500 U/h. Although numerous opportunities for medication errors exist with the use of U-500 insulin, this case outlines the safe use of concentrated intravenous insulin when clinically indicated for patients requiring extremely high doses of insulin to control blood glucose.

scholarly journals EATING AND GLYCEMIC CONTROL AMONG CRITICALLY ILL PATIENTS RECEIVING CONTINUOUS INTRAVENOUS INSULIN

2020 ◽  
Vol 26 (1) ◽  
pp. 43-50
Author(s):  
Eli E. Miller ◽  
Mumtu Lalla ◽  
Alyssa Zaidi ◽  
May Elgash ◽  
Huaqing Zhao ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Blood Glucose ◽  
Glycemic Control ◽  
Coefficient Of Variation ◽  
Apache Ii Score ◽  
Weighted Mean ◽  
Icu Patients ◽  
Intravenous Insulin ◽  
Significant Difference

Objective: Consensus guidelines recommend that intensive care unit (ICU) patients with blood glucose (BG) levels >180 mg/dL receive continuous intravenous insulin (CII). The effectiveness of CII at controlling BG levels among patients who are eating relative to those who are eating nothing by mouth (nil per os; NPO) has not been described. Methods: We conducted a retrospective cohort study of 260 adult patients (156 eating, 104 NPO) admitted to an ICU between January 1, 2014, and December 31, 2014, who received CII. Patients were excluded for a diagnosis of diabetic ketoacidosis or hyperglycemic hyperosmolar nonketotic syndrome, admission to an obstetrics service, or receiving continuous enteral or parenteral nutrition. Results: Among 22 baseline characteristics, the proportion of patients receiving glucocorticoid treatment (GCTx) (17.3% eating, 37.5% NPO; P<.001) and APACHE II score (15.0 ± 7.5 eating, 17.9 ± 7.9 NPO; P = .004) were significantly different between eating and NPO patients. There was no significant difference in the primary outcome of patient-day weighted mean BG overall (153 ± 8 mg/dL eating, 156 ± 7 mg/dL NPO; P = .73), or day-by-day BG ( P = .37) adjusted for GCTx and APACHE score. Surprisingly, there was a significant difference in the distribution of BG values, with eating patients having a higher percentage of BG readings in the recommended range of 140 to 180 mg/dL. However, eating patients showed greater glucose variability (coefficient of variation 23.1 ± 1.0 eating, 21.2 ± 1.0 NPO; P = .034). Conclusion: Eating may not adversely affect BG levels of ICU patients receiving CII. Whether or not prandial insulin improves glycemic control in this setting should be studied. Abbreviations: BG = blood glucose; CII = continuous insulin infusion; CV = coefficient of variation; HbA1c = hemoglobin A1c; ICU = intensive care unit; NPO = nil per os; PDWMBG = patient day weighted mean blood glucose

Implementing an intravenous insulin infusion protocol in the intensive care unit

2007 ◽  
Vol 64 (4) ◽  
pp. 385-395 ◽  
Author(s):  
Rhonda S. Rea ◽  
Amy Calabrese Donihi ◽  
MaryBeth Bobeck ◽  
Peter Herout ◽  
Teresa P. McKaveney ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Insulin Infusion ◽  
Intravenous Insulin ◽  
Insulin Infusion Protocol ◽  
Infusion Protocol

Nurse-Led Implementation of a Safe and Effective Intravenous Insulin Protocol in a Medical Intensive Care Unit

2011 ◽  
Vol 31 (6) ◽  
pp. 27-35 ◽  
Author(s):  
Rabia Khalaila ◽  
Eugene Libersky ◽  
Dina Catz ◽  
Elina Pomerantsev ◽  
Abed Bayya ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Blood Glucose ◽  
Medical Intensive Care Unit ◽  
Control Group ◽  
Glucose Levels ◽  
Intravenous Insulin ◽  
Blood Glucose Levels ◽  
Protocol Group ◽  
Medical Intensive Care

BackgroundRecent evidence has linked tight glucose control to worsened clinical outcomes among adults in intensive care units.ObjectiveTo evaluate the effectiveness and safety of a nurse-led intravenous insulin protocol designed to achieve conservative blood glucose control in patients in a medical intensive care unit.MethodsA nurse-led intravenous insulin protocol was developed, targeting blood glucose levels at 110 to 149 mg/dL. Hypoglycemia was defined as a blood glucose level less than 70 mg/dL. Patients admitted to the medical intensive care unit who required an insulin infusion were enrolled in the study. Blood glucose levels in those patients were compared with levels in 153 historical control patients admitted to the unit in the 12 months before the protocol was implemented who required an insulin infusion.ResultsNinety-six patients were enrolled and treated with the protocol. The protocol and control groups had similar characteristics at baseline. More measurements in the protocol group than in the control group (46.3% vs 36.1%, P&lt;.001) were within the target glucose range (110–149 mg/dL). Hyperglycemia (blood glucose ≥200 mg/dL) occurred less often in the protocol group than in the control group (14.8% vs 20.1%, P=.003). Hypoglycemic events (blood glucose &lt;70 mg/dL) also occurred less often in the protocol group (0.07% vs 0.83%, P&lt;.001).ConclusionsImplementation of a nurse-led, conservative intravenous insulin protocol in the medical intensive care unit is effective and safe and markedly reduces the rate of hypoglycemia.

Continuous Intravenous Insulin: An Evaluation in Bariatric Patients Outside of the Intensive Care Unit

2012 ◽  
Vol 7 (4) ◽  
pp. 172-182
Author(s):  
Melanie E. Mabrey ◽  
Allison Vorderstrasse ◽  
Mary Champagne ◽  
Lisa Clark Pickett
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Intravenous Insulin ◽  
Bariatric Patients

scholarly journals Accuracy of Capillary and Arterial Whole Blood Glucose Measurements Using a Glucose Meter in Patients under General Anesthesia in the Operating Room

2017 ◽  
Vol 127 (3) ◽  
pp. 466-474 ◽  
Author(s):  
Brad S. Karon ◽  
Leslie J. Donato ◽  
Chelsie M. Larsen ◽  
Lindsay K. Siebenaler ◽  
Amy E. Wells ◽  
...  
Keyword(s):  
Blood Glucose ◽  
General Anesthesia ◽  
Operating Room ◽  
Whole Blood ◽  
Insulin Infusion ◽  
Subcutaneous Insulin ◽  
Intravenous Insulin ◽  
Diabetes Status ◽  
Glucose Meter ◽  
Arterial Glucose

Abstract Background The aim of this study was to evaluate the use of a glucose meter with surgical patients under general anesthesia in the operating room. Methods Glucose measurements were performed intraoperatively on 368 paired capillary and arterial whole blood samples using a Nova StatStrip (Nova Biomedical, USA) glucose meter and compared with 368 reference arterial whole blood glucose measurements by blood gas analyzer in 196 patients. Primary outcomes were median bias (meter minus reference), percentage of glucose meter samples meeting accuracy criteria for subcutaneous insulin dosing as defined by Parkes error grid analysis for type 1 diabetes mellitus, and accuracy criteria for intravenous insulin infusion as defined by Clinical and Laboratory Standards Institute guidelines. Time under anesthesia, patient position, diabetes status, and other variables were studied to determine whether any affected glucose meter bias. Results Median bias (interquartile range) was −4 mg/dl (−9 to 0 mg/dl), which did not differ from median arterial meter bias of −5 mg/dl (−9 to −1 mg/dl; P = 0.32). All of the capillary and arterial glucose meter values met acceptability criteria for subcutaneous insulin dosing, whereas only 89% (327 of 368) of capillary and 93% (344 of 368) arterial glucose meter values met accuracy criteria for intravenous insulin infusion. Time, patient position, and diabetes status were not associated with meter bias. Conclusions Capillary and arterial blood glucose measured using the glucose meter are acceptable for intraoperative subcutaneous insulin dosing. Whole blood glucose on the meter did not meet accuracy guidelines established specifically for more intensive (e.g., intravenous insulin) glycemic control in the acute care environment.

Blood glucose on day of intensive care unit admission as a surrogate of subsequent glucose control in intensive care

2006 ◽  
Vol 21 (2) ◽  
pp. 197-202 ◽  
Author(s):  
Moritoki Egi ◽  
Rinaldo Bellomo ◽  
Eddie Stachowski ◽  
Craig J. French ◽  
Graeme Hart ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Blood Glucose ◽  
Intensive Care Unit Admission ◽  
Glucose Control
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