A pilot study to evaluate the effectiveness of glargine and multiple injections of lispro in patients with type 2 diabetes receiving tube feedings in a cardiovascular intensive care unit.
BACKGROUND
The purpose of this study was to evaluate the effectiveness of insulin lispro and insulin glargine at controlling blood glucose in patients with type 2 diabetes mellitus in a cardiovascular intensive care unit (CICU) and receiving enteral tube feedings.


METHODS
This was a pilot study with a retrospective control designed to evaluate an insulin protocol in patients admitted to the CICU in a level 3 teaching institution. Patients were 18-99 years of age with type 2 diabetes mellitus, receiving bolus tube feeding. The control group included 24 patients who were retrospectively studied to determine mean blood glucose level. A glycemic management protocol was developed that included glargine and lispro insulins to maintain blood glucose levels between 80 and 140 mg/dL. The study group consisted of 28 patients who were treated according to the glycemic management protocol.


RESULTS
The mean blood glucose level of the retrospective control group was 225 mg/dL. The mean blood glucose level of the intervention group was 148 mg/dL. After protocol institution, 48.6% of blood glucose levels were within the goal blood glucose range of 80-140 mg/dL vs 8.26% (p = .01) before protocol institution. Hyperglycemia decreased from 90.0% to 47.2% (p < .0001) with institution of the protocol.


CONCLUSIONS
The average blood glucose of the intervention group was slightly above the goal blood glucose range of 80-140 mg/dL; however, the study protocol was superior to the previous CICU blood glucose management protocol.
Grainger
Angela
A
Barnes Jewish College of Nursing and Allied Health, 306 S. Kingshighway Blvd., St. Louis, MO 63110, USA. angie.g25@gmail.com
Eiden
Kelly
K
Kemper
Judy
J
Reeds
Dominic
D
D000368:Aged; D001786:Blood Glucose / Q000378:metabolism*; D003422:Critical Care / Q000379:methods; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy*; D004750:Enteral Nutrition; D005260:Female; D006760:Hospitalization; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000188:drug therapy*; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007328:Insulin / Q000031:analogs & derivatives / Q000627:therapeutic use; D000069036:Insulin Glargine; D061268:Insulin Lispro; D049528:Insulin, Long-Acting; D008297:Male; D010865:Pilot Projects; D012189:Retrospective Studies; D016896:Treatment Outcome
D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin; D061268:Insulin Lispro; D049528:Insulin, Long-Acting; D000069036:Insulin Glargine