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Glucose Management in Diabetes Inpatient Setting - Focus On Intravenous Insulin (Dokter)
Glucose Management in Diabetes Inpatient Setting - Focus On Intravenous Insulin (Dokter)
Glucose Management in Diabetes Inpatient Setting - Focus On Intravenous Insulin (Dokter)
In-hospital hyperglycemia is defined as blood glucose (BG) levels > 140 mg/dL in hospitalized patients1
High infection rates Increased duration of hospital stay High mortality rates
~3X times more infection
Risk of complications Higher mortality rates in
rates in patients with
increased 3% for each 18 patients with BG > 200 mg/dl
BG > 220 mg/dl on first
mg/dl increase in admission vs. BG < 200 mg/dl
postoperative day vs.
glucose (5.0% vs. 1.8%, p < 0.001)
BG < 220 mg/dl
Reference: 1. ADA 2020 [Internet]. Available at https://care.diabetesjournals.org/content/43/Supplement_1. Accessed on 28 Nov, 2020. 2. Management of Diabetes and Hyperglycemia in Hospitalized Patients [Internet]. Available at: https://www.ncbi.nlm.nih.gov/books/NBK279093/.
Accessed on 09 Dec, 2020.
Pathophysiology Of Hyperglycemia in Intensive Care Unit
Perkeni, Perdici, Perdossi, Perki. Penatalaksanaan Hiperglikemia Di Unit Rawat Intensif. 2018. Jakarta
Glycemic management of critically ill hospitalized patients
ADA 2021
• Centers with extensive experience and appropriate nursing support, cardiac surgical patients, and patients with
stable glycemic control without hypoglycemia
Individualized glycemic goal; depends on patient’s clinical condition
0.5-1 ml of fluid is flushed across the IV tube to prevent adhesion of the tube
Other way if syringe pump not available : 50 – 100 U of regular insulin or rapid acting
analogue insulin is dissolved in 50 – 100 cc NaCl 0.9% using micro drip infusion set
PERKENI, PERDICI, PERDOSSI, PERKI. PENATALAKSANAAN HIPERGLIKEMIA DI UNIT RAWAT INTENSIF. 2018. Jakarta
S Restu, meta, Rahardjo, Sri, Mahmud. Jurnal Komplikasi Anestesi, 2015; 69-84
Conversion to subcutaneous insulin
WHEN. ??
• Stable blood glucoses which are less than 180 mg/dL (7.7–10 mmol/L) for at least
4–6 h consecutively
• Normal anion gap and resolution of acidosis in DKA
• Stable clinical status; hemodynamic stability
• Not on vasopressors
• Stable nutrition plan or patient is eating
• Stable IV drip rates (low variability)
BG, blood glucose; CF, correction factor; IV, intravenous; SC, subcutaneous; TDD, total daily dose.
Bode BW, et al. Endocr Pract. 2004;10(suppl 2):71-80.
Can rapid acting analog insulins be
administered intravenously?
Study of Continuous Insulin Infusion Protocols in the Medical
Intensive Care Unit by using Glulisine
Multicenter randomized trial of 153 ICU patients randomized to CII using the Glucommander (n=77) or a standard
paper protocol (n=76). Both protocols used glulisine insulin and targeted blood glucose (BG) between 80 mg/dL and 120 mg/dL.
• Both treatment
algorithms resulted in
significant improvement
in glycemic control in
critically ill patients in
the medical ICU.
Standard (n) 77 77 55 35 24 14 13 10 7 7 3
Glucommander (n) 76 76 50 37 31 32 18 17 15 11 8
Glucose (mmol/L)
arm (insulin glulisine infusion in the 4 <0.0005
68 Subjects
with DKA
Given 1/2 as glargine OD, and 1/2 as Given 2/3 as NPH, and 1/3 as regular
glulisine before meals insulin twice daily
Hyperglycemia is associated with increased morbidity & mortality both in DM patient and non DM
Control of hyperglycemia levels with a target of 140-180 mg / dl can decrease mortality and
morbidity
The use of continuous intravenous insulin can control hyperglycemia in a relatively short time
Insulin analog such as glulisine can be used for IV infusion.
Tight monitoring of blood sugar levels can reduce the risk of hypoglycemia