Safety and efficacy of a graduated intravenous insulin infusion protocol in critically ill trauma patients receiving specialized nutritional support.
OBJECTIVE
The intent of this study was to evaluate the safety and efficacy of our protocol for providing continuous intravenous regular human insulin (RHI) infusion to hyperglycemic critically ill trauma patients receiving specialized nutritional support.


METHODS
Capillary blood glucose (BG) concentrations were determined every 1-2 h. Glucose control was defined as a BG concentration in the target range of 70-149 mg/dL (3.9-8.3 mmol/L). Data were recorded for 1 d before the RHI infusion and for a maximum of 8 d thereafter while receiving the RHI infusion.


RESULTS
Forty adult critically ill trauma patients received 102 +/- 62 units of RHI daily for 10 +/- 6 d. BG control was achieved within 5 +/- 3 h. BG decreased from 194 +/- 55 mg/dL (10.8 +/- 3.1 mmol/L) to 134 +/- 19 mg/dL (7.4 +/- 1.1 mmol/L) after 1 d of RHI infusion (P < 0.001). Average daily BG ranged from 119 to 124 mg/dL and the target range was maintained for 19.6 +/- 4.7 h/d. None of the patients experienced severe hypoglycemia (<40 mg/dL); 14 patients had asymptomatic hypoglycemia (<60 mg/dL or <3.3 mmol/L) for a total of 23 episodes out of 4140 measurements (0.56%). Estimated creatinine clearance for those with hypoglycemia was 69 +/- 32 mL/min compared with 117 +/- 58 mL/min for the others (P < 0.01).


CONCLUSIONS
Our protocol was safe and effective for the management of hyperglycemia in critically ill trauma patients receiving specialized nutritional support but should be used with caution in patients with renal insufficiency.
Dickerson
Roland N
RN
Department of Clinical Pharmacy, University of Tennessee Health Science Center, Memphis, TN, USA. rdickerson@utmem.edu
Swiggart
Cortney E
CE
Morgan
Laurie M
LM
Maish
George O
GO
Croce
Martin A
MA
Minard
Gayle
G
Brown
Rex O
RO
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D001786:Blood Glucose / Q000187:drug effects* / Q000378:metabolism; D016638:Critical Illness / Q000628:therapy*; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000188:drug therapy*; D007003:Hypoglycemia / Q000139:chemically induced / Q000453:epidemiology; D007262:Infusions, Intravenous; D007328:Insulin / Q000009:adverse effects / Q000627:therapeutic use*; D007332:Insulin Infusion Systems / Q000009:adverse effects; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012449:Safety; D016896:Treatment Outcome
D001786:Blood Glucose; D007328:Insulin