title: Insulin infusion therapy in critical care patients: regular insulin vs short-acting insulin. A prospective, crossover, randomized, multicenter blind study.
abstract: BACKGROUND
  The aim of this multicenter, prospective, randomized, crossover trial is to compare, in critical care patients receiving insulin infusion therapy (IIT), the pharmacodynamic of Humulin insulin (Hlin), currently used as "standard of care," and Humalog insulin (Hlog), a shorter acting insulin formulation. This was measured as extent and duration of the carryover effect of insulin treatment, with the latter calculated as ratio between blood glucose concentration (BGC) reduction during and after IIT.
  
  
  METHODS
  Twenty-eight patients treated in an intensive care unit and receiving full nutritional support were randomly assigned to Hlin or Hlog as first treatment. Insulin was infused at a constant rate in patients presenting with BGC greater than or equal to 180 mg/dL (0.04 U/kg per hour) and was discontinued when BGC was less than or equal to 140 mg/dL (therapeutic BGC drop). Further reductions in BGC after discontinuation of insulin infusion were recorded (postinfusional BGC drop). During the study period, whole blood BGC was measured every 30 minutes. A minimal 6-hour washout interval was maintained between treatments with the 2 types of insulin. The primary end point was the extent (calculated as ratio between the therapeutic BGC drop and the postinfusional BGC drop) and duration of the carryover effect.
  
  
  RESULTS
  Treatment with Hlog, as compared with Hlin, was associated with a less profound carryover effect as well as a briefer duration of carryover (median, 0.40 vs 0.62; P < .001; median, 1 vs 1.5 hours; P < .001).
  
  
  CONCLUSIONS
  The use of constant Hlog infusion for IIT, when compared with Hlin at the same dose, is associated with a less profound carryover effect on BGC after discontinuation of IIT, a briefer duration of carryover, a faster BGC drop during infusion, and a quicker BGC rise after discontinuation. These characteristics suggest that Hlog IIT may be preferable for use in critically ill patients.
authors.affiliation: Department of Anesthesiology, Critical Care and Pain Medicine, Neuroanesthesia and Neurocritical Care, "Sapienza" University of Rome, Rome, Italy. Electronic address: bilotta@tiscali.it.
authors.forename: Federico
authors.initials: F
authors.lastname: Bilotta
authors.affiliation: Department of Anesthesiology and Surgical Intensive Care, Hospital Clinic Universitari Valencia, Valencia, Spain.
authors.forename: Rafael
authors.initials: R
authors.lastname: Badenes
authors.affiliation: Department of Anesthesiology, Critical Care and Pain Medicine, Neuroanesthesia and Neurocritical Care, "Sapienza" University of Rome, Rome, Italy.
authors.forename: Simona
authors.initials: S
authors.lastname: Lolli
authors.affiliation: Department of Anesthesiology and Surgical Intensive Care, Hospital Clinic Universitari Valencia, Valencia, Spain.
authors.forename: Francisco Javier
authors.initials: FJ
authors.lastname: Belda
authors.affiliation: Department of Anesthesiology and General Intensive Care Unit, Shaare Zedek Medical Centre, Jerusalem, Israel.
authors.forename: Sharon
authors.initials: S
authors.lastname: Einav
authors.affiliation: Department of Anesthesiology, Critical Care and Pain Medicine, Neuroanesthesia and Neurocritical Care, "Sapienza" University of Rome, Rome, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Rosa
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose / Q000032:analysis*; D003422:Critical Care; D018592:Cross-Over Studies; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000188:drug therapy*; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D007328:Insulin / Q000008:administration & dosage; D061268:Insulin Lispro / Q000008:administration & dosage*; D061386:Insulin, Regular, Human / Q000008:administration & dosage*; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016037:Single-Blind Method; D055815:Young Adult
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin; D061268:Insulin Lispro; D061386:Insulin, Regular, Human
keywords: Critical care; Hyperglycemia; Hypoglycemia; Insulin infusion therapy; Regular insulin; Short acting insulin