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11-02-2017 | Hypoglycemia | Review | Article

Hypoglycemia Reduction Strategies in the ICU

Journal:
Current Diabetes Reports

Authors: Susan Shapiro Braithwaite, Dharmesh B. Bavda, Thaer Idrees, Faisal Qureshi, Oluwakemi T. Soetan

Publisher: Springer US

Abstract

Purpose of Review

We reviewed the strategies associated with hypoglycemia risk reduction among critically ill non-pregnant adult patients.

Recent Findings

Hypoglycemia in the ICU has been associated with increased mortality in a number of studies. Insulin dosing and glucose monitoring rules, response to impending hypoglycemia, use of computerization, and attention to modifiable factors extrinsic to insulin algorithms may affect the risk for hypoglycemia. Recurring use of intravenous (IV) bolus doses of insulin in insulin-resistant cases may reduce reliance upon higher IV infusion rates.

Summary

In order to reduce the risk for hypoglycemia in the ICU, caregivers should define responses to interruption of continuous carbohydrate exposure, incorporate transitioning strategies upon initiation and interruption of IV insulin, define modifications of antihyperglycemic therapy in the presence of worsening renal function or chronic kidney disease, and anticipate the effects traceable to other medications and substances. Institutional and system-wide quality improvement efforts should assign priority to hypoglycemia prevention.

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