title: Tight glycaemic control: clinical implementation of protocols.
abstract: 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.
authors.affiliation: Department of Endocrinology, Onze-Lieve-Vrouw Hospital, Moorselbaan 164, 9300 Aalst, Belgium. frank.nobels@olvz-aalst.be
authors.forename: Frank
authors.initials: F
authors.lastname: Nobels
authors.forename: Patrick
authors.initials: P
authors.lastname: Lecomte
authors.forename: Natascha
authors.initials: N
authors.lastname: Deprez
authors.forename: Inge
authors.initials: I
authors.lastname: Van Pottelbergh
authors.forename: Paul
authors.initials: P
authors.lastname: Van Crombrugge
authors.forename: Luc
authors.initials: L
authors.lastname: Foubert
mesh_terms: 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
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin