title: Inpatient management of hyperglycemia: the Northwestern experience.
abstract: OBJECTIVE
  To describe a novel method of safe and effective intensive management of inpatient hyperglycemia with use of cost-effective protocols directed by a glucose management service (GMS).
  
  
  METHODS
  An intravenous insulin protocol was designed to achieve a glycemic target of 80 to 110 mg/dL. When stable inpatients were transferred from the intravenous protocol to a subcutaneous insulin protocol, which consisted of basal long-acting and prandial and supplemental rapid-acting insulins, the blood glucose target was 80 to 150 mg/dL. Glucose levels were reviewed by the GMS at least daily for protocol adjustments, when necessary.
  
  
  RESULTS
  The intravenous insulin protocol was used in 276 patients, and 4,058 capillary blood glucose levels were recorded. Glycemic target levels (80 to 110 mg/dL) were achieved, on average, 10.6 +/- 5.2 hours after initiation of insulin drip therapy. The mean capillary blood glucose level during the study interval was 135.3 +/- 49.9 mg/dL. Hypoglycemia (< or = 60 mg/dL) was recorded in 1.5% of glucose values, and hyperglycemia (> or = 400 mg/dL) was recorded in only 0.06%. The subcutaneous insulin protocol was used in 922 patients, and 18,067 capillary glucose levels were documented. The mean blood glucose level was 145.6 +/- 55.8 mg/dL during the study period. The blood glucose target of 80 to 150 mg/dL was achieved in 58.6%, whereas 74.3% of glycemic values were in the clinically acceptable range (80 to 180 mg/dL). Hypoglycemia (< or = 60 mg/dL) occurred in 1.3% of capillary blood glucose values, and hyperglycemia (> or = 400 mg/dL) occurred in 0.4% of values.
  
  
  CONCLUSIONS
  Validated protocols dedicated to the achievement of strict glycemic goals were implemented by a GMS and resulted in substantial improvements in glycemic control on the surgical inpatient services, with a reduced frequency of hypoglycemia. The protocols and the GMS have been well received by the inpatient nursing and surgical staff members, and all of this has been done in a cost-effective manner.
authors.affiliation: Division of Endocrinology, Metabolism and Molecular Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, USA.
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: DeSantis
authors.forename: Lowell R
authors.initials: LR
authors.lastname: Schmeltz
authors.forename: Kathleen
authors.initials: K
authors.lastname: Schmidt
authors.forename: Eileen
authors.initials: E
authors.lastname: O'Shea-Mahler
authors.forename: Connie
authors.initials: C
authors.lastname: Rhee
authors.forename: Angela
authors.initials: A
authors.lastname: Wells
authors.forename: Stephen
authors.initials: S
authors.lastname: Brandt
authors.forename: Sara
authors.initials: S
authors.lastname: Peterson
authors.forename: Mark E
authors.initials: ME
authors.lastname: Molitch
mesh_terms: D000368:Aged; D000465:Algorithms; D001786:Blood Glucose / Q000032:analysis; D002641:Chicago / Q000453:epidemiology; D048909:Diabetes Complications / Q000188:drug therapy; D003920:Diabetes Mellitus / Q000097:blood; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000188:drug therapy*; D007262:Infusions, Intravenous; D007279:Injections, Subcutaneous; D007297:Inpatients / Q000706:statistics & numerical data*; D007328:Insulin / Q000008:administration & dosage* / Q000627:therapeutic use; D008297:Male; D021661:Management Service Organizations; D008875:Middle Aged; D010865:Pilot Projects
chemical_list: D001786:Blood Glucose; D007328:Insulin