Management of critically ill patients with diabetes.
Disorders of glucose homeostasis, such as stress-induced hypoglycemia and hyperglycemia, are common complications in patients in the intensive care unit. Patients with preexisting diabetes mellitus (DM) are more susceptible to hyperglycemia, as well as a higher risk from glucose overcorrection, that may results in severe hypoglycemia. In critically ill patients with DM, it is recommended to maintain a blood glucose range between 140-180 mg/dL. In neurological patients and surgical patients, tighter glycemic control (i.e., 110-140 mg/d) is recommended if hypoglycemia can be properly avoided. There is limited evidence that shows that critically ill diabetic patients with a glycosylated hemoglobin levels above 7% may benefit from looser glycemic control, in order to reduce the risk of hypoglycemia and significant glycemic variability.
Livier Josefina Silva-Perez, Mario Alberto Benitez-Lopez, Department of Medicine, Autonomous University of Baja California, School of Medicine, Tijuana, BC 22260, Mexico.
Livier Josefina
LJ
Silva-Perez
Livier Josefina Silva-Perez, Mario Alberto Benitez-Lopez, Department of Medicine, Autonomous University of Baja California, School of Medicine, Tijuana, BC 22260, Mexico.
Mario Alberto
MA
Benitez-Lopez
Livier Josefina Silva-Perez, Mario Alberto Benitez-Lopez, Department of Medicine, Autonomous University of Baja California, School of Medicine, Tijuana, BC 22260, Mexico.
Joseph
J
Varon
Livier Josefina Silva-Perez, Mario Alberto Benitez-Lopez, Department of Medicine, Autonomous University of Baja California, School of Medicine, Tijuana, BC 22260, Mexico.
Salim
S
Surani
Critical care; Diabetes mellitus; Glycemic control; Hypoglycemia; Intensive care unit; Stress hyperglycemia