Tight glycaemic control: clinical implementation of protocols.
Implementation of tight glycaemic control in hospitalised patients presents a huge challenge. It concerns many patients, there are many interfering factors and many health-care professionals are involved. The current literature provides little practical guidance. This article offers the clinical anesthesiologist direction for the organisation of inpatient blood glucose control in acute situations, in the perioperative setting and in the intensive care unit. An effective, safe and user-friendly algorithm for intravenous insulin administration is presented that can be executed by regular nurses and used in many situations. Practical advice is offered for the use of subcutaneous basal-bolus insulin, for fasting orders and for transition to discharge care. The main safety considerations are discussed.
Nobels
Frank
F
Department of Endocrinology, Onze-Lieve-Vrouw Hospital, Moorselbaan 164, 9300 Aalst, Belgium. frank.nobels@olvz-aalst.be
Lecomte
Patrick
P
Deprez
Natascha
N
Van Pottelbergh
Inge
I
Van Crombrugge
Paul
P
Foubert
Luc
L
D000465:Algorithms; D000776:Anesthesiology / Q000379:methods; D001786:Blood Glucose / Q000187:drug effects* / Q000378:metabolism; D003422:Critical Care / Q000379:methods; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D007328:Insulin / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D019990:Perioperative Care / Q000379:methods; D017410:Practice Guidelines as Topic
D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin