Conversion from Continuous Insulin Infusions to Subcutaneous Insulin in Critically III Patients

2009 ◽  
Vol 43 (4) ◽  
pp. 629-634 ◽  
Author(s):  
Kyle A Weant ◽  
Alim Ladha
Keyword(s):  
Blood Glucose ◽  
Insulin Infusion ◽  
Insulin Requirement ◽  
Study Data ◽  
Target Range ◽  
Subcutaneous Insulin ◽  
Subcutaneous Dose ◽  
Target Values ◽  
Significant Difference ◽  
History Of

Background: Continuous insulin infusions have become a standard of care in many intensive care units (ICUs); however, methods for transitioning patients from continuous infusions to other insulin therapies have not been extensively evaluated. Objective: To determine the most effective method for transitioning ICU patients from continuous insulin infusions to subcutaneous insulin therapy. Methods: A searchable pharmacy database at the University of North Carolina Hospitals was used to retrospectively identify adults admitted to the neurosurgery ICU and prescribed a continuous insulin infusion between May 2007 and February 2008, All patients were transitioned to subcutaneous insulin upon floor transfer. Patients were stratified according to the dose of subcutaneous insulin as a percentage of their prior 24-hour continuous insulin requirement and then analyzed on the rate of achievement of goal blood glucose values (80–150 mg/dL) within the first 48 hours after transition. Results: A total of 769 blood glucose values from 79 patients were recorded during the study. Data analysis demonstrated significantly lower median blood glucose values with the use of subcutaneous insulin doses that were 60–70% of insulin infusion requirements when compared with all other groups. For patients without a history of diabetes mellitus, the use of a subcutaneous dose that was 60–70% of the insulin infusion requirement resulted in a significantly greater percentage of patients within the target range compared with other groups (78%; p < 0.05). For those with a history of diabetes, subcutaneous doses higher than 70% of the insulin infusion requirement yielded the most frequent achievement of target values, although there was substantial variability within this group. No significant difference was noted in the incidence of hypoglycemia (blood glucose <80 mg/dL) between groups, although the frequency of hypoglycemia was almost twice as high in the group with diabetes as in those without it (4.2% vs 2.2%). Conclusions: Methods currently used to transition patients off insulin infusions vary widely. Initial data suggest that utilizing 60–70% of the 24-hour insulin infusion requirement as a subcutaneous dose would result in blood glucose values of 80–150 mg/dL 70% of the time. Further study is necessary to adequately assess the optimal insulin infusion transition protocol for critically ill patients to ensure both safety and efficacy.

Converting Continuous Insulin Infusion to Subcutaneous Insulin Glargine After Cardiac Surgery Using Percentage-Based Versus Weight-Based Dosing: A Pilot Trial

2013 ◽  
Vol 47 (1) ◽  
pp. 20-28 ◽  
Author(s):  
Kevin M Silinskie ◽  
Ronald Kirshner ◽  
Mindee S Hite
Keyword(s):  
Cardiac Surgery ◽  
Blood Glucose ◽  
Insulin Glargine ◽  
Insulin Infusion ◽  
Insulin Dose ◽  
Pilot Trial ◽  
Blood Glucose Monitoring ◽  
Target Range ◽  
Subcutaneous Insulin ◽  
Continuous Insulin Infusion

BACKGROUND Most studies report using percentage of total daily insulin (TDI) for converting therapy from continuous insulin infusion to subcutaneous insulin in cardiac surgery patients. Few studies have evaluated the efficacy of using body weight to calculate the basal insulin dose. OBJECTIVE To compare the efficacy and safety of dosing insulin glargine by weight versus percentage of TDI in cardiac surgery patients transitioning from continuous insulin infusion to subcutaneous insulin. METHODS We conducted a prospective, randomized, open-label, pilot study. Study patients who had a preoperative weight less than 100 kg and were receiving at least 6 hours of a continuous insulin infusion were randomized to receive either 50% of their TDI requirement or 0.5 units/kg of glargine as a one-time dose 2 hours before stopping the continuous insulin infusion. All patients were administered subcutaneous corrective insulin. Blood glucose monitoring occurred before each meal, at bedtime, and with morning laboratory tests for 24 hours after administration of the glargine dose. RESULTS A total of 200 blood glucose measurements were performed in each group. The percentage of blood glucose measurements in target range (80–140 mg/dL) was similar between the weight-based group and the percentage-based group (66% vs 64%, p = 0.75). Median blood glucose after transition was 120 mg/dL (interquartile range [IQR] 99–147) in the weight-based group compared to 127 mg/dL (IQR 107–149; p = 0.03) in the percentage-based group. The median glargine dose was higher in the weight-based group (41 units; IQR 36–44) than in the weight-based group (24 units; IQR 14–30, p < 0.001). The rate of hypoglycemia (blood glucose <60 mg/dL) was 2.5% in each group. CONCLUSIONS In this small cohort, dosing insulin glargine by weight proved to be safe, but larger scale studies are needed before adopting weight-based dosing in this patient population.

Clinical Usefulness of a Bolus Calculator in Maintaining Normoglycaemia in Active Professional Patients with Type 1 Diabetes Treated with Continuous Subcutaneous Insulin Infusion

2008 ◽  
Vol 36 (5) ◽  
pp. 1112-1116 ◽  
Author(s):  
T Klupa ◽  
T Benbenek-Klupa ◽  
M Malecki ◽  
M Szalecki ◽  
J Sieradzki
Keyword(s):  
Type 1 Diabetes ◽  
Blood Glucose ◽  
Metabolic Control ◽  
Continuous Subcutaneous Insulin Infusion ◽  
Insulin Infusion ◽  
Target Range ◽  
Subcutaneous Insulin ◽  
Glucose Levels ◽  
Blood Glucose Levels

This observational study assessed metabolic control in young, active professionals with type 1 diabetes treated with continuous subcutaneous insulin infusion (CSII) with or without the use of a bolus calculator. Eighteen patients aged 19 − 51 years with diabetes duration of 6 − 22 years were included; eight patients used a bolus calculator and 10 did not. Metabolic control was assessed by glycosylated haemoglobin (HbA1c) measurements and blood glucose profiles. A continuous glucose monitoring system (CGMS) was also used by three patients from each group. Mean HbA1c and fasting blood glucose levels were not significantly different between the two groups, but mean post-prandial blood glucose was significantly lower in bolus calculator users than non-users. The CGMS showed more blood glucose levels within the target range in bolus calculator users than non-users, but statistical significance was not achieved. In conclusion, a bolus calculator may help to improve post-prandial blood glucose levels in active professional type 1 diabetes patients treated with CSII, but does not have a major impact on HbA1c levels.

scholarly journals Topical problems of diabetes treatment during pregnancy

2009 ◽  
Vol 12 (4) ◽  
pp. 32-36
Author(s):  
Irina Yur'evna Demidova ◽  
Natalya Yur'evna Arbatskaya ◽  
Elena Petrovna Mel'nikova
Keyword(s):  
Diabetes Mellitus ◽  
Blood Glucose ◽  
Insulin Therapy ◽  
Pregnant Women ◽  
Intensive Insulin Therapy ◽  
Insulin Requirement ◽  
Subcutaneous Insulin ◽  
Diabetes Treatment ◽  
Self Monitoring ◽  
Stable Control

The main causes behind decompensation of diabetes mellitus (DM) in pregnant women are consid-ered, such as metabolic and hormonal disturbancesinfluencing insulin requirement in different periods of pregnancy and variability of glycemia related to pharmacokinetic and pharmacodynamicproperties of insu-lin preparations. Recommended target levels of glycemia in pregnant women with DM are cited. The fre-quencyof self-monitoring blood glucose and principles of intensive insulin therapy are discussed. Advan-tages of continuous subcutaneous insulin infusionand its role in the maintenance of stable control of car-bohydrate metabolism during pregnancy are discussed.

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.

Comparative analysis of different drug delivery methods of injectable hydrogel nanomaterials of insulin biomaterials via multiple daily injections and continuous subcutaneous insulin infusion in the treatment of type 1 diabetes mellitus in children

2021 ◽  
Vol 11 (7) ◽  
pp. 1154-1160
Author(s):  
Yan Sun ◽  
Haoshu Niu ◽  
Zhixia Wang ◽  
Ying Wang ◽  
Xuechun Li ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Drug Delivery ◽  
Type 1 Diabetes ◽  
Blood Glucose ◽  
Type 1 Diabetes Mellitus ◽  
Continuous Subcutaneous Insulin Infusion ◽  
Insulin Infusion ◽  
Insulin Dosage ◽  
Subcutaneous Insulin

The aim of this study was to investigate the difference between multiple daily injections (MDI) and continuous subcutaneous insulin infusion (CSII) in blood glucose control during the treatment of type 1 diabetes mellitus (T1DM) in children. under the nano-hydrogel delivery carrier. In order to improve the efficiency and therapeutic effect of the experiment, this paper adopts injectable nanomaterial-polymer composite hydrogel as drug delivery system to cooperate with insulin injection to improve the effective utilization of drugs. Eighty children diagnosed with T1DM by the department of Endocrinology, Genetics, and Metabolism of INNER MONGOLIA BAOGANG Hospital from October 2018 to December 2019 were selected as research subjects for this study. The children were randomly divided into MDI group (treated with MDI) and CSII group (treated with CSII), with 40 children in each group. The basic data of the children were compared, and changes in hemoglobin A1c (HbA1c) at admission and 1, 2, and 3 months after treatment were detected. During the detection, the blood glucose level, therapeutic time of blood glucose normalization, and daily insulin dosage were recorded. The HbA1c and fasting blood glucose (FBG) were followed up three months after discharge, and incidences of hypoglycemia in the two groups were observed. The results showed that the mean value of HbA1c in the MDI group was higher than that in the CSII group (P < 0.05). Each patient was assessed for the number of times their blood sugar was allowed to dip below normal levels; patients with less hypoglycemia had a higher rate of blood sugar control. The control rates of blood glucose in the MDI and CSII groups were 19.21% and 23.50%, respectively. The CSII group showed significantly higher blood glucose rates than the MDI group (P < 0.05). The therapeutic time of blood glucose normalization in the MDI group was significantly longer than that in the CSII group (P < 0.05). There was no significant difference in the average daily insulin dosage between the MDI and CSII groups (P > 0.05), which indicated that CSII therapy had significant advantages in reducing blood glucose in children with T1DM.

Long-Term Safety and Efficacy of Programmable Implantable Insulin Delivery Systems

1993 ◽  
Vol 16 (12) ◽  
pp. 847-854 ◽  
Author(s):  
C.L. Olsen ◽  
G. Liu ◽  
M. Iravani ◽  
S. Nguyen ◽  
K. Khourdadjian ◽  
...  
Keyword(s):  
Blood Glucose ◽  
Standard Deviation ◽  
Insulin Infusion ◽  
Glycated Hemoglobin ◽  
Severe Hypoglycemia ◽  
Insulin Delivery ◽  
Delivery Systems ◽  
Subcutaneous Insulin ◽  
Safety And Efficacy

Objectives Since only short-term studies of continuous intraperitoneal insulin infusion (CIPII) therapy using implantable programmable insulin delivery systems have been performed to show this method of diabetes therapy to be safe and efficacious, we have performed long-term studies to assess its safety and efficacy. Research design and methods For 78 patient-years of follow-up, we have longitudinally studied the incidence of diabetic ketoacidosis and severe hypoglycemia in 25 type 1 diabetic patients treated with CIPII. We also compared, cross-sectionally, the long-term safety and efficacy of CIPII to intensive subcutaneous insulin therapy using intermittent injections or continuous subcutaneous insulin infusion. Finally, we examined the relationship between glycated hemoglobin levels and the standard deviation of daily blood glucose excursion. Results Cross-sectional analysis revealed similar degrees of metabolic control accompanied by significantly decreased rates of both ketoacidosis (0.013 events/patient/year) and severe hypoglycemia (0.05 events/patient/year) during CIPII compared to intermittent injections and continuous subcutaneous insulin infusion therapy. A four-fold decrease in the rate of severe hypoglycemia was observed during longitudinal comparison of pre- and post-implantation complication rates. A relationship was also shown between decreased levels of mean glycated hemoglobin and the standard deviation of blood glucose excursions during CIPII therapy. Conclusions Our data demonstrate that long-term therapy with CIPII is as effective as other methods in achieving near-normal levels of glycated hemoglobin, which in CIPII is associated with a decreased standard deviation of blood glucose excursions. Further, CIPII using implantable programmable insulin delivery systems is the safest method described for intensive insulin therapy in home blood glucose monitoring type 1 diabetic patients.

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