Case discussion in blood glucose variability

Charles C. Reed, Randy D. Beadle, Susan D. Gerhardt, Gail L. Kongable, Ronald M. Stewart

Research output: Contribution to journalArticlepeer-review

3 Scopus citations

Abstract

Stress-induced hyperglycemia has been associated with poor outcomes and death in critically ill patients. Blood glucose (BG) variability, a component of stress-related hyperglycemia has recently been reported as a significant independent predictor of intensive care unit and hospital mortality. We sought to evaluate three cases in which intensive insulin therapy was administered using a standardized insulin dosing protocol to normalize the BG and reduce glycemic variability. Point-of-care BG values and other clinical measures were obtained from the medical record of three patients who received intensive insulin therapy. This was a convenience sample of three patients where the BG level had stabilized on a consistent intravenous insulin dose rate for up to 20 hours in a surgical trauma intensive care unit. Data were collected manually and electronically using the Remote Automated Laboratory System-Tight Glycemic Control Module (RALS-TGCM®) BG management and monitoring system. Each case presentation describes a critically ill, nondiabetic patient, requiring continuous intravenous insulin therapy for hyperglycemia. In each instance, BG variability was present in a worsening patient condition after a period of normalization of hyperglycemia with intensive insulin therapy. Although decreasing BG variability is an important aspect of hyperglycemia management, new onset events of variability may be a sentinel warning or occur as a physiologic response to a worsening patient condition. If so, these events warrant rapid investigation and treatment of the underlying problem.

Original languageEnglish (US)
Pages (from-to)70-74
Number of pages5
JournalJournal of Neuroscience Nursing
Volume43
Issue number2
DOIs
StatePublished - Apr 2011

ASJC Scopus subject areas

  • Surgery
  • Endocrine and Autonomic Systems
  • Clinical Neurology
  • Medical–Surgical

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