Comparisons of different insulin infusion protocols: a review of recent literature.
OBJECTIVE
To provide an update on the currently available insulin infusion protocols for treatment of hyperglycemia in critically ill patients and to discuss the major differences and similarities among them.


RESULTS
We identified a total of 26 protocols, 20 of which used manual blood-glucose calculations, and six that used computerized algorithms. The major differences and similarities among the insulin infusion protocols were in the following areas: patient characteristics, target glucose level, time to achieve target glucose level, incidence of hypoglycemia, rationale for adjusting the rates of insulin infusion, and methods of blood-glucose measurements. Several computerized protocols hold promise for safer achievement of glycemic targets.


CONCLUSIONS
Insulin infusion is the most effective method for controlling hyperglycemia in critically ill patients. Clinicians should utilize a validated insulin infusion protocol that is well tolerated, and is most appropriate and practical for their institution based on the resources that are available.
Krikorian
Armand
A
Department of Medicine, Case Western Reserve University, Cleveland, Ohio 44106, USA. armand.krikorian@uhhospitals.org
Ismail-Beigi
Faramarz
F
Moghissi
Etie S
ES
D000465:Algorithms; D001786:Blood Glucose / Q000378:metabolism; D002985:Clinical Protocols; D003422:Critical Care / Q000379:methods*; D016638:Critical Illness; D006801:Humans; D006943:Hyperglycemia / Q000188:drug therapy*; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D007262:Infusions, Intravenous; D007328:Insulin / Q000008:administration & dosage*
D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin