Delay in blood glucose monitoring during an insulin infusion protocol is associated with increased risk of hypoglycemia in intensive care units.
BACKGROUND
Hypoglycemia during insulin infusion therapy is a major problem. We investigated whether a delay in blood glucose (BG) monitoring during an insulin infusion protocol (IIP) in the intensive care unit (ICU) is associated with hypoglycemia.


METHODS
Data were collected for 50 consecutive patients treated with Brigham and Women's Hospital's IIP. Point-of-care BG values were obtained from the bedside paper flow sheets and the exact times of individual measurements were ascertained from an internet-based glucose meter download program. Data were carefully studied for protocol time violations, defined as a delay of >10 minutes after the recommended time for BG measurement.


RESULTS
A total of 2309 BG values were evaluated for time violation. A total of 1474 (63.9%) measurements had been obtained at the recommended time or earlier; 835 (36.1%) measurements had been obtained >10 minutes after the recommended time for measurement. There were a significantly higher proportion of BG values <80 mg/dL following the time violation as compared to no time violation (17.8% versus 11.6%; P < 0.001).


CONCLUSIONS
We conclude that the risk of hypoglycemia during insulin infusion therapy is higher after a delay in BG measurement.
Garg
Rajesh
R
Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA. rgarg@partners.org
Jarry
Amy
A
Pendergrass
Merri
M
D000368:Aged; D001786:Blood Glucose / Q000187:drug effects / Q000378:metabolism*; D015190:Blood Glucose Self-Monitoring / Q000009:adverse effects / Q000379:methods; D005260:Female; D006801:Humans; D007003:Hypoglycemia / Q000097:blood* / Q000139:chemically induced; D007328:Insulin / Q000008:administration & dosage / Q000009:adverse effects; D007332:Insulin Infusion Systems / Q000009:adverse effects*; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000009:adverse effects / Q000379:methods; D012307:Risk Factors; D013997:Time Factors
D001786:Blood Glucose; D007328:Insulin