Low-dose intensive insulin therapy in patients with Acute Coronary Syndrome accompanied by Left Ventricular Failure: audit of two UK hospitals.
OBJECTIVE
To determine whether a low-dose intravenous insulin regimen reduces blood glucose levels at a timely rate and associated side effects among patients with Acute Coronary Syndrome and Left Ventricular Failure.


BACKGROUND
Induced hypoglycaemia and the associated risks have questioned the benefits of intensive insulin therapy in patients presenting with raised blood glucose levels and Acute Coronary Syndromes. Local audit data identified that patients with Acute Coronary Syndrome and Left Ventricular Failure experienced more hypoglycaemic episodes than those with Acute Coronary Syndrome alone. Consequently, a new regimen of low-dose insulin for this group was implemented and audited over 12 months.


METHODS
Audit.


METHODS
Thirty-six consecutive patient notes with a diagnosis of Acute Coronary Syndrome and blood glucose of ≥10 mmol/l treated with a new insulin therapy regimen were analysed. Data were extracted using a standardised form and entered into an Excel spreadsheet for analysis.


RESULTS
The mean age of the sample was 70 years with 66% of subjects being men and 50% presenting with Acute Coronary Syndrome and Left Ventricular Failure. The low-dose regimen was effective in achieving normoglycaemia, (range 4-8 mmol/l) for a consecutive six-hour period. This was achieved in 72% of patients and within a median time of 13 hours.


CONCLUSIONS
The audit suggests that a low-dose insulin regimen can effectively stabilise blood glucose in patients presenting with both Acute Coronary Syndrome and Left Ventricular Failure. The importance of regularly monitoring blood sugar levels is vital and highlights the role of nurses in minimising patient risk and promoting safety.


CONCLUSIONS
Nurses are instrumental in the safe implementation of intensive insulin guidelines. Close monitoring of patients is essential, enabling timely adjustments to treatments and ensuring patient safety. Regular audits allow nurses to evaluate care provision and continue to drive practice forward.
Cardiac Rehabilitation Department, North Bristol NHS Trust, Southmead Hospital, Bristol, UK. Nicola.manning@nbt.nhs.uk.
Nicola
N
Manning
Centre for Clinical and Health Science Research, Faculty of Health & Social Care, University of the West of England, Bristol, UK.
John W
JW
Albarran
D054058:Acute Coronary Syndrome; D000368:Aged; D001786:Blood Glucose / Q000032:analysis; D005260:Female; D006333:Heart Failure; D006761:Hospitals; D006801:Humans; D006943:Hyperglycemia / Q000150:complications / Q000188:drug therapy* / Q000451:nursing; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007328:Insulin / Q000627:therapeutic use*; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D013222:State Medicine; D006113:United Kingdom
D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin
Left Ventricular Failure; acute coronary syndrome; hyperglycaemia; hypoglycaemia; intensive insulin therapy; safety