title: Adapting to the new consensus guidelines for managing hyperglycemia during critical illness: the updated Yale insulin infusion protocol.
abstract: OBJECTIVE
  To report our preliminary experience with the revised, more conservative Yale insulin infusion protocol (IIP) that targets blood glucose concentrations of 120 to 160 mg/dL.
  
  
  METHODS
  We prospectively tracked clinical responses to the new IIP in our medical intensive care unit (ICU) by recording data on the first 115 consecutive insulin infusions that were initiated. All blood glucose values; insulin doses; nutritional support including intravenous dextrose infusions; caloric values for enteral and parenteral nutrition; and use of vasopressors, corticosteroids, and hemodialysis or continuous venovenous hemodialysis were collected from the hospital record.
  
  
  RESULTS
  The IIP was used 115 times in 90 patients (mean age, 62 [±14 years]; 51% male; 35% ethnic minorities; 66.1% with history of diabetes). The mean admission Acute Physiology and Chronic Health Evaluation II score was 24.4 (±7.5). The median duration of insulin infusion was 59 hours. The mean baseline blood glucose concentration was 306.1 (±89.8) mg/dL, with the blood glucose target achieved after a median of 7 hours. Once the target was reached, the mean IIP blood glucose concentration was 155.9 (±22.9) mg/dL (median, 150 mg/dL). The median insulin infusion rate required to reach and maintain the target range was 3.5 units/h. Hypoglycemia was rare, with 0.3% of blood glucose values recorded being less than 70 mg/dL and only 0.02% being less than 40 mg/dL. In all cases, hypoglycemia was rapidly corrected using intravenous dextrose with no evident untoward outcomes.
  
  
  CONCLUSIONS
  The updated Yale IIP provides effective and safe targeted blood glucose control in critically ill patients, in compliance with recent national guidelines. It can be easily implemented by hospitals now using the original Yale IIP.
authors.affiliation: Department of Medicine, Griffin Hospital, Derby, Connecticut, USA.
authors.forename: Shilpa
authors.initials: S
authors.lastname: Shetty
authors.forename: Silvio E
authors.initials: SE
authors.lastname: Inzucchi
authors.forename: Philip A
authors.initials: PA
authors.lastname: Goldberg
authors.forename: Dawn
authors.initials: D
authors.lastname: Cooper
authors.forename: Mark D
authors.initials: MD
authors.lastname: Siegel
authors.forename: Shyoko
authors.initials: S
authors.lastname: Honiden
mesh_terms: D000368:Aged; D001786:Blood Glucose / Q000032:analysis; D015331:Cohort Studies; D003237:Connecticut; D003422:Critical Care / Q000379:methods*; D003920:Diabetes Mellitus / Q000097:blood / Q000188:drug therapy* / Q000451:nursing; D016903:Drug Monitoring / Q000379:methods*; D005260:Female; D006284:Health Plan Implementation; D006801:Humans; D006943:Hyperglycemia / Q000517:prevention & control*; D007003:Hypoglycemia / Q000517:prevention & control; D007004:Hypoglycemic Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D007262:Infusions, Intravenous; D061386:Insulin, Regular, Human / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D013997:Time Factors
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D061386:Insulin, Regular, Human