title: Case discussion in blood glucose variability.
abstract: Stress-induced hyperglycemia has been associated with poor outcomes and death in critically ill patients. Blood glucose (BG) variability, a component of stress-related hyperglycemia has recently been reported as a significant independent predictor of intensive care unit and hospital mortality. We sought to evaluate three cases in which intensive insulin therapy was administered using a standardized insulin dosing protocol to normalize the BG and reduce glycemic variability. Point-of-care BG values and other clinical measures were obtained from the medical record of three patients who received intensive insulin therapy. This was a convenience sample of three patients where the BG level had stabilized on a consistent intravenous insulin dose rate for up to 20 hours in a surgical trauma intensive care unit. Data were collected manually and electronically using the Remote Automated Laboratory System-Tight Glycemic Control Module (RALS-TGCM) BG management and monitoring system. Each case presentation describes a critically ill, nondiabetic patient, requiring continuous intravenous insulin therapy for hyperglycemia. In each instance, BG variability was present in a worsening patient condition after a period of normalization of hyperglycemia with intensive insulin therapy. Although decreasing BG variability is an important aspect of hyperglycemia management, new onset events of variability may be a sentinel warning or occur as a physiologic response to a worsening patient condition. If so, these events warrant rapid investigation and treatment of the underlying problem.
authors.affiliation: Surgical Trauma/Neurosurgical ICU, University Hospital, San Antonio, TX, USA. charles.reed@uhs-sa.com
authors.forename: Charles C
authors.initials: CC
authors.lastname: Reed
authors.forename: Randy D
authors.initials: RD
authors.lastname: Beadle
authors.forename: Susan D
authors.initials: SD
authors.lastname: Gerhardt
authors.forename: Gail L
authors.initials: GL
authors.lastname: Kongable
authors.forename: Ronald M
authors.initials: RM
authors.lastname: Stewart
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000378:metabolism*; D001930:Brain Injuries / Q000378:metabolism* / Q000451:nursing; D016638:Critical Illness; D004509:Education, Nursing, Continuing; D005260:Female; D016489:Head Injuries, Closed / Q000378:metabolism* / Q000451:nursing; D006801:Humans; D006943:Hyperglycemia / Q000188:drug therapy / Q000378:metabolism* / Q000451:nursing; D007004:Hypoglycemic Agents / Q000008:administration & dosage; D007262:Infusions, Intravenous; D007328:Insulin / Q000008:administration & dosage; D008297:Male; D009104:Multiple Trauma / Q000378:metabolism* / Q000451:nursing
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin