Glucommander: a computer-directed intravenous insulin system shown to be safe, simple, and effective in 120,618 h of operation.
OBJECTIVE
Intravenous insulin is now the recommended method of diabetes management in critically ill persons in the hospital. The published methods for administering the insulin are complex and are usually limited to intensive care units with a low patient-to-nurse ratio.


METHODS
A computer-directed algorithm for advice on the delivery of intravenous insulin that is flexible in blood glucose timing and advises insulin dosing in a graduated manner has been developed. This software program, known as the Glucommander, has been used extensively by our group. The data were analyzed for this study.


RESULTS
The data from 5,080 intravenous insulin runs over 120,683 h show that blood glucose levels can be safely stabilized in a target range without significant hypoglycemia by nonspecialized nurses working on any unit of a general hospital. The mean glucose level reached <150 mg/dl in 3 h. Only 0.6% of all glucose values were <50 mg/dl. The prevalence of hypoglycemia <40 mg/dl was 2.6% of all runs. No hypoglycemia was severe.


CONCLUSIONS
This computer-directed algorithm is a simple, safe, effective, and robust method for maintaining glycemic control. It has been extensively studied and is applicable in a wide variety of conditions. In contrast to other published intravenous insulin protocols, which have been limited to intensive care units, Glucommander can be used in all units of any hospital.
Davidson
Paul C
PC
Atlanta Diabetes Associates, Suite 2080, Atlanta, GA 30309, USA. paul_c_davidson@msn.com
Steed
R Dennis
RD
Bode
Bruce W
BW
D000465:Algorithms; D001786:Blood Glucose / Q000187:drug effects / Q000378:metabolism; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000188:drug therapy* / Q000451:nursing; D005069:Evaluation Studies as Topic; D006757:Hospital Units; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D007275:Injections, Intravenous; D007328:Insulin / Q000008:administration & dosage*; D008510:Medication Systems, Hospital; D009741:Nursing Staff, Hospital; D012984:Software; D013813:Therapy, Computer-Assisted / Q000295:instrumentation* / Q000379:methods
D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin