Higher insulin infusion rate but not 24-h insulin consumption is associated with hypoglycemia in critically ill patients.
OBJECTIVE
To assess the association between insulin infusion rates, and 24-h insulin consumption on hypoglycemia in the intensive care unit (ICU).


METHODS
This was a retrospective case-control study, conducted at an academic institution in the United States. Adult patients admitted to the ICU receiving intravenous insulin infusions for blood glucose control were included. Hypoglycemic (blood glucose <70 mg/dL) patients were matched 1:1 with non-hypoglycemic controls based on age, gender, and body mass index. Multivariable conditional logistic regression analyses were conducted to determine the effect of: (1) weight-adjusted insulin infusion rate (units/kg/h), (2) non-weight-adjusted insulin infusion rate (units/h), or (3) 24-h insulin consumption (units/day) on hypoglycemia.


RESULTS
A total of 122 patients were included in the study (61 cases, 61 controls). Compared to those patients who received <0.05 units/kg/h, the odds of hypoglycemia was higher in those who received was ≥0.1 units/kg/h (OR 4.57, 95% CI 1.45-14.41, p=0.010). Compared to those patients who received <4 units/h, the odds of hypoglycemia was higher in those who received was ≥8 units/h (4.17, 95% CI 1.18-14.75, p=0.027). The risk of hypoglycemia did not increase with higher 24-h insulin consumption.


CONCLUSIONS
Higher insulin infusion rates rather than 24-h insulin consumption may be associated with hypoglycemia in critically ill patients in the ICU.
Pharmacy Department, St. Joseph's Hospital and Medical Center, Phoenix, AZ 85013, United States.
John J
JJ
Radosevich
Department of Pharmacy Practice and Science, College of Pharmacy, The University of Arizona, 1295 N Martin Ave, PO Box 210202, Tucson, AZ 85721, United States. Electronic address: Patanwala@pharmacy.arizona.edu.
Asad E
AE
Patanwala
Department of Pharmacy Practice and Science, College of Pharmacy, The University of Arizona, 1295 N Martin Ave, PO Box 210202, Tucson, AZ 85721, United States.
Paul D
PD
Frey
Department of Pharmacy Practice and Science, College of Pharmacy, The University of Arizona, 1295 N Martin Ave, PO Box 210202, Tucson, AZ 85721, United States.
Yong G
YG
Lee
Department of Pharmacy Practice and Science, College of Pharmacy, The University of Arizona, 1295 N Martin Ave, PO Box 210202, Tucson, AZ 85721, United States.
Holly
H
Paddock
Department of Pharmacy Practice and Science, College of Pharmacy, The University of Arizona, 1295 N Martin Ave, PO Box 210202, Tucson, AZ 85721, United States.
Brian L
BL
Erstad
D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000032:analysis; D015992:Body Mass Index; D001835:Body Weight; D016022:Case-Control Studies; D016638:Critical Illness; D005260:Female; D006801:Humans; D007003:Hypoglycemia / Q000097:blood*; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D007262:Infusions, Intravenous / Q000379:methods*; D007328:Insulin / Q000008:administration & dosage / Q000627:therapeutic use*; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin
Critical care; Critical illness; Hypoglycemia; Insulin; Intensive care