Research Article

Achieving durable glucose control in the intensive care unit without hypoglycaemia : a new practical IV insulin protocol

  1. Michael Balkin1,2,*,
  2. Charles Mascioli1,
  3. Virginia Smith3,
  4. Hicham Alnachawati2,
  5. Sandeep Mehrishi2,
  6. Ghulam Saydain2,
  7. Helen Slone4,
  8. Joseph Alessandrini5,
  9. Lawrence Brown1

Article first published online: 28 JUL 2006

DOI: 10.1002/dmrr.673

Issue

Diabetes/Metabolism Research and Reviews

Diabetes/Metabolism Research and Reviews

Volume 23, Issue 1, pages 49–55, January 2007

Additional Information

How to Cite

Balkin, M., Mascioli, C., Smith, V., Alnachawati, H., Mehrishi, S., Saydain, G., Slone, H., Alessandrini, J. and Brown, L. (2007), Achieving durable glucose control in the intensive care unit without hypoglycaemia : a new practical IV insulin protocol. Diabetes/Metabolism Research and Reviews, 23: 49–55. doi: 10.1002/dmrr.673

Author Information

  1. 1

    Department of Medicine, Huntington Hospital, 270 Park Avenue, Huntington. New York, USA

  2. 2

    Department of Medicine, Nassau University Medical Center, 2201 Hempstead Turnpike, East Meadow, New York, USA

  3. 3

    Division of Nursing, Huntington Hospital, 270 Park Avenue, Huntington, New York, USA

  4. 4

    Department of Medicine, South Jersey Regional Medical Center, 1505 West Sherman Avenue, Vineland, NJ, 08360, USA

  5. 5

    Department of Pharmacy, South Jersey Regional Medical Center, 1505 West Sherman Avenue, Vineland, NJ, 08360, USA

*191 E. Main St, Huntington, NY 11743, New York.

Publication History

  1. Issue published online: 28 DEC 2006
  2. Article first published online: 28 JUL 2006
  3. Manuscript Accepted: 8 JUN 2006
  4. Manuscript Revised: 4 JUN 2006
  5. Manuscript Received: 16 MAR 2006

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Keywords:

  • stress hyperglycaemia;
  • insulin infusion protocol;
  • critical care unit

Abstract

Background

Hyperglycaemia occurs in a substantial portion of critically ill patients in our intensive care units. Near normalization of elevated blood glucose levels with IV insulin may improve outcome. However, currently published IV insulin protocol are not ideal; most are relatively complex and often result in hypoglycaemia. We designed a protocol that would be practical to use while incorporating the necessary complexities required to achieve good glucose control, coupled with a low incidence hypoglycaemia.

Methods

The essential part of the protocol is a matrix specifying the amount by which an insulin flow rate is to be changed. The intersection of the current and the previous blood glucose values on the matrix locates the appropriate cell containing the required change in insulin flow rate. No additional calculations or tables are required.

Results

The initial glucose level obtained by blood glucose meter (BGM) averaged 253.5 ± 95.6 mg/dL and fell below 140 within 9.3 h on the protocol. The average BGM on the protocol was 133.5 ± 43.9 mg/dL. Only 0.09% of all glucose values were <40 mg/dL and insulin had to be held only 2.2% of the time on the protocol. Physician input was not required and nursing accuracy in applying the protocol was greater than 94%. This protocol has been adopted as the default IV insulin protocol for the NorthShore-LIJ Health System and several other medical centers.

Conclusion

A practical IV insulin protocol that has been extensively tested is presented. The protocol has been implemented at multiple institutions indicating its ease of use and excellent results. Copyright © 2006 John Wiley & Sons, Ltd.

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