Hypoglycemia in the intensive care unit

Current Opinion in Clinical Nutrition and Metabolic Care

Volumn 10, Issue 2, 2007, Pages 193-196

  Mechanick, Jeffrey I ^a,c   Handelsman, Yehuda ^b   Bloomgarden, Zachary T ^a  

^a MOUNT SINAI SCHOOL OF MEDICINE   (United States)

^b Metabolic Institute of America   (United States)

^c NONE   (United States)

Author keywords

Critical illness; Hyperglycemia; Hypoglycemia; ICU; Intensive insulin therapy

Indexed keywords

GLUCOSE; INSULIN; OCTREOTIDE;

ACUTE CORONARY SYNDROME; ADRENERGIC STIMULATION; CORONARY ARTERY BYPASS GRAFT; CRITICAL ILLNESS; DIABETES MELLITUS; FLUID THERAPY; GLUCOSE BLOOD LEVEL; GLUCOSE UTILIZATION; HEART STROKE VOLUME; HEMOFILTRATION; HUMAN; HYPOGLYCEMIA; INCIDENCE; INTENSIVE CARE; MITOGENESIS; MORTALITY; NUTRITIONAL SUPPORT; POTASSIUM CELL LEVEL; REVIEW; RISK FACTOR; SEPSIS; SIDE EFFECT; TREATMENT OUTCOME;

BLOOD GLUCOSE; HUMANS; HYPOGLYCEMIA; HYPOGLYCEMIC AGENTS; INSULIN; INTENSIVE CARE; INTENSIVE CARE UNITS; RISK FACTORS; TREATMENT OUTCOME;

EID: 33846855753     PISSN: 13631950     EISSN: 15353885     Source Type: Journal    
DOI: 10.1097/MCO.0b013e32802b7016     Document Type: Review

References (30)

1. van den Berghe G, Wouters P, Weekers F, et al. Intensive insulin therapy in critically ill patients. N Engl J Med 2001; 345:1359-1367.
2. American College of Endocrinology Task Force on Inpatient Diabetes and Metabolic Control. American College of Endocrinology Position Statement on Inpatient Diabetes and Metabolic Control. Endocr Pract 2004; 10:77-82.
3. ACE/ADA Task Force on Inpatient Diabetes. American College of Endocrinology and American Diabetes Association consensus statement on inpatient diabetes and glycemic control. Endocr Pract 2006; 12: 458-468.
4. Mechanick JI. Metabolic mechanisms of stress hyperglycemia. JPEN J Parenter Enteral Nutr 2006; 30:157-163.
5. Mesotten D, van den Berghe G. Clinical potential of insulin therapy in critically ill patients. Drugs 2003; 63:625-636.
6. van den Berghe G, Wouters PJ, Bouillon R, et al. Outcome benefit of intensive insulin therapy in the critically ill: insulin dose versus glycemic control. Crit Care Med 2003; 31:359-366.
7. Cryer PE. Hypoglycaemia: the limiting factor in the glycaemic management of the critically ill? Diabetologia 2006; 49:1722-1725.
8. van den Berghe G, Wilmer A, Hermans G, et al. Intensive insulin therapy in the medical ICU. N Engl J Med 2006; 354:449-461. This is a landmark study, not only describing a benefit of IIT among medical ICU patients that survive at least 3 days, but also demonstrating a salient difference in response to IIT between medical ICU and previously studied surgical ICU patients. In addition, the risk for severe hypoglycemia is significantly greater among medical ICU patients. Details of the nutritional and glycemic parameters of study patients in this report can only be obtained by examining Table A in the Supplementary Appendix (http://eresources.library.mssm.edu:2368/cgi/data/354/5/ 449/DC1/1; accessed 7 October 2006).
9. Lazar HL, Chipkin SR, Fitzgerald CA, et al. Tight glycemic control in diabetic coronary artery bypass graft patients improves perioperative outcomes and decreases recurrent ischemic events. Circulation 2004; 109:1497-1502.
10. Pittas AG, Siegel RD, Lau J. Insulin therapy for critically ill hospitalized patients: a meta-analysis of randomized controlled trials. Arch Intern Med 2004; 164:2005-2011.
11. Zerr KJ, Furnary AP, Grunkemeier GL, et al. Glucose control lowers the risk of wound infection in diabetics after open heart operations. Ann Thorac Surg 1997; 63:356-361.
12. Furnary AP, Zerr KJ, Grunkemeier GL, Starr A. Continuous intravenous insulin infusion reduces the incidence of deep sternal wound infection in diabetic patients after cardiac surgical procedures. Ann Thorac Surg 1999; 67:352-360.
13. Bloomgarden ZT. Perspectives on the news: cardiovascular disease. Diabetes Care 2006; 29:1160-1166.
14. Gabriely I, Shamoon H. Hypoglycemia in diabetes: common, often unrecognized. Cleve Clin J Med 2004; 71:335-342.
15. Braithwaite SS, Buie MM, Thompson CL, et al. Hospital hypoglycemia: not only treatment but also prevention. Endocr Pract 2004; 10 (Suppl 2):89-99.
16. Vriesendorp TM, van Santen S, DeVries JH, et al. Predisposing factors for hypoglycemia in the intensive care unit. Crit Care Med 2006; 34:96-101. This large study specifically examines clinical parameters that are associated with hypoglycemia in the ICU.
17. •] by the same authors.
18. Egi M, Bellomo R, Stachowski E, et al. Intensive insulin therapy in postoperative intensive care unit patients. Am J Resp Crit Care Med 2006;173:407-413. This Australian study suggests that in order to save one life in the ICU with IIT, the cost will be several patients' experiencing a severe hypoglycemic episode. Moreover, the exact cost varies, depending on the particular medical institution. Therefore, clinicians need to know the performance of their own intensive insulin algorithm for prudent decision-making.
19. Svensson AM, McGuire DK, Abrahamsson P, Dellborg M. Association between hyper- and hypoglycaemia and 2 year all-cause mortality risk in diabetic patients with acute coronary events. Eur Heart J 2005; 26:1255-1261.
20. Vanhorebeek I, Langouche L, Van den Berghe G. Intensive insulin therapy in the intensive care unit: update on clinical impact and mechanisms of action. Endocr Pract 2006; 12 (Suppl 3):14-21.
21. ClinicalTrials.gov. Efficacy of volume substitution and insulin therapy in severe sepsis (VISEP trial). http://clinicaltrials.gov/show/NCT00135473. [Accessed 21 April 2006].
22. Kanji S, Singh A, Tierney M, et al. Standardization of intravenous insulin therapy improves the efficiency and safety of blood glucose control in critically ill adults. Intensive Care Med 2004; 30:804-810.
23. Chant C, Wilson G, Friedrich JO. Validation of an insulin infusion nomogram for intensive glucose control in critically ill patients. Pharmacotherapy 2005; 25:352-359.
24. Brunkhorst FM, Kuhnt E, Engel C, et al. Intensive insulin therapy in patient with severe sepsis and septic shock is associated with an increased rate of hypoglycemia - results from a randomized multicenter study (VISEP). Infection 2005; 33 (suppl 1):19. This is a critical study that was aborted because of the observed significantly increased frequency of hypoglycemia without any demonstrable benefit on mortality. Elderly patients were at particularly high risk for hypoglycemia and death.
25. Toft P, Jørgensen HS, Toennesen E, et al. Intensive insulin therapy to noncardiac ICU patients: a prospective study. Eur J Anaesthesiol 2006; 23:705-709.
26. Plank J, Blaha J, Cordingley J, et al. Multicentric, randomized, controlled trial to evaluate blood glucose control by the model predictive control algorithm versus routine glucose management protocols in intensive care unit patients. Diabetes Care 2006; 29:271-276.
27. Goldberg PA, Sakharova OV, Barrett PW, et al. Improving glycemic control in the cardiothoracic intensive care unit: clinical experience in two hospital settings. J Cardiothorac Vasc Anesth 2004; 18:690-697.
28. Krinsley JS. Effect of an intensive glucose management protocol on the mortality of critically ill adult patients. Mayo Clin Proc 2004; 79:992-1000.
29. Osburne RC, Cook CB, Stockron L, et al. Improving hyperglycemia management in the intensive care unit. Diab Educator 2006; 32:394-403.
30. Taylor BE, Schallom ME, Sona CS, et al. Efficacy and safety of an insulin infusion protocol in a surgical ICU. J Am Coll Surg 2006; 202:1-9.