title: Insulin infusion protocol for critical care units.
abstract: OBJECTIVE
  An insulin infusion protocol for critical care units is described.
  
  
  CONCLUSIONS
  Evidence that aggressive glycemic control improves outcomes led physicians, nurses, dietitians, and pharmacists at a trauma center to develop an insulin infusion protocol. Before the protocol, elevated blood glucose concentrations were often not treated until they reached 200 mg/dL or higher. Insulin infusions were underutilized and were often not started until capillary blood glucose concentrations were greater than 350 mg/dL for 12 or more hours. When orders for an insulin infusion were written, they did not include directions for dosage adjustment, and the goal blood glucose range varied. A preliminary protocol was drafted allowing adjustments in insulin administration to be based on changes in capillary blood glucose values since the previous blood glucose measurement. The protocol was presented to a multidisciplinary team and further refined. The targeted blood glucose concentration range was 80-130 mg/dL. After the targeted range was achieved for a patient, if the blood glucose level continued to decrease over three consecutive measurements, the infusion rate was decreased by 0.5 or 1 unit/hr, depending on the capillary blood glucose level. Data for the first 30 patients were collected from September 2003 to August 2004. It took 2-36 hours (mean, 12.6 hours) to bring the capillary blood glucose concentration to less than 130 mg/dL. Among 2,845 capillary blood glucose measurements, there were 15 cases of hypoglycemia (0.4%) requiring treatment with 50% dextrose injection.
  
  
  CONCLUSIONS
  A multidisciplinary effort resulted in the development of an insulin infusion protocol for use in critical care units.
authors.affiliation: Department of Pharmacy, Bayfront Medical Center (BMC), St. Petersburg, FL 33701, USA. dimple.dilkhush@bayfront.org
authors.forename: Dimple
authors.initials: D
authors.lastname: Dilkhush
authors.forename: Jeffry
authors.initials: J
authors.lastname: Lannigan
authors.forename: Tressa
authors.initials: T
authors.lastname: Pedroff
authors.forename: Anthie
authors.initials: A
authors.lastname: Riddle
authors.forename: Mary
authors.initials: M
authors.lastname: Tittle
mesh_terms: D002985:Clinical Protocols; 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; D007362:Intensive Care Units; D008991:Monitoring, Physiologic; D010348:Patient Care Team
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin