Intravenous insulin nomogram improves blood glucose control in the critically ill.
OBJECTIVE
To improve control of blood glucose concentrations in critically ill patients through use of a bedside, nurse-managed, intravenous insulin nomogram.


METHODS
Retrospective, before-after cohort study.


METHODS
Fifteen-bed mixed medical/surgical intensive care unit in a tertiary, teaching hospital.


METHODS
A total of 167 intensive care unit patients requiring intravenous insulin infusions during two 9-month periods.


METHODS
The sliding scale group was treated using ad hoc sliding scale infusion therapy. The intervention group was treated using a dosing nomogram that allowed the nurse to adjust the insulin infusion rate based on current glucose concentration and concurrent insulin infusion rates. The adjustments were made independent of physician input.


RESULTS
Time from initiating the insulin infusion to initial control of glucose concentration (<11.5 mmol/L) was determined. Effectiveness of glucose control was determined retrospectively by measuring the area under the curve of blood concentrations >11.5 mmol/L versus time of insulin infusion, divided by total duration of insulin infusion. The median time to initial control of glucose (<11.5 mmol/L) was 4 hr (range 1-38 hr) for the baseline and 2 hr (range 1-22 hr) for nomogram group (p =.0004). The median area under the curve of glucose concentration divided by duration of insulin infusion was 0.9 (range 0.0-5.9) for sliding scale group and 0.3 (range 0.0-11.1) for nomogram (p =.0001), without any increase in the frequency of episodes of hypoglycemia.


CONCLUSIONS
Use of an insulin nomogram in critically ill patients improves control of blood glucose concentrations and is safe.
Brown
G
G
Pharmacy, St. Paul's Hospital, Vancouver, BC, Canada. gbrown@providencehealth.bc.ca
Dodek
P
P
D019540:Area Under Curve; D001786:Blood Glucose / Q000187:drug effects*; D003422:Critical Care / Q000379:methods*; D006801:Humans; D006943:Hyperglycemia / Q000188:drug therapy*; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D007262:Infusions, Intravenous; D007328:Insulin / Q000008:administration & dosage / Q000627:therapeutic use*; D007902:Length of Stay; D008875:Middle Aged; D009732:Nursing Care; D012189:Retrospective Studies
D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin