Hyperglycemia during acute coronary syndrome: a nurse-managed insulin infusion protocol for stricter and safer control.
BACKGROUND
Diabetic patients with acute coronary syndromes (ACS) might benefit from tight glycemic control by means of insulin infusion. Nurse-implemented insulin infusion protocols (IIP) are available but none validated in patients with ACS admitted to a coronary care unit (CCU).


OBJECTIVE
To assess feasibility, effectiveness and safety of a new nurse-managed IIP (Desio Diabetes Diagram, DDD) for intensive glucose control in patients with suspected ACS and known diabetes or blood glucose (BG) >200 mg/dL.


RESULTS
To reach and maintain a target BG level of 100-139 mg/dL we adopted a nomogram based on the percent changes in the insulin infusion rate according to the current BG value and the percent change from previous BG level. Ninety-one consecutive patients (53 men, mean age 69.7+/-11.2 years) were treated with DDD IIP. Baseline BG was 202.2+/-86.8 mg/dL. The median time to achieve the target was 3 h (Q1-Q3 2-5 h). Afterwards target BG levels were maintained for 70.4+/-15.9% of the time. During 5004 h of insulin infusion BG never fell below 40 mg/dL.


CONCLUSIONS
The nurse-managed DDD IIP was easily implemented in our CCU and permitted strict and safe glycemic control in hyperglycemic patients with ACS.
Avanzini
Fausto
F
Division of Cardiology and Coronary Care Unit, General Hospital, 20033 Desio (MI), Italy. avanzini@marionegri.it
Marelli
Giuseppe
G
Donzelli
Walter
W
Sorbara
Loredana
L
Palazzo
Enzo
E
Bellato
Laura
L
Colombo
Elena Lucia
EL
Roncaglioni
Maria Carla
MC
Riva
Emma
E
De Martini
Mario
M
D054058:Acute Coronary Syndrome / Q000150:complications / Q000451:nursing*; D000368:Aged; D001291:Attitude of Health Personnel; D001786:Blood Glucose / Q000187:drug effects; D003325:Coronary Care Units; D003422:Critical Care / Q000379:methods; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000188:drug therapy / Q000451:nursing; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000188:drug therapy / Q000451:nursing; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000150:complications / Q000188:drug therapy* / Q000451:nursing*; D007003:Hypoglycemia / Q000139:chemically induced / Q000451:nursing / Q000517:prevention & control; D007004:Hypoglycemic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D007262:Infusions, Intravenous / Q000379:methods / Q000451:nursing*; D007328:Insulin / Q000008:administration & dosage* / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D013041:Specialties, Nursing / Q000379:methods
D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin