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Glycemic Control and Insulin Resistance

  • Richard N. Lesperance
  • Oscar D. Guillamondegui
Chapter

Abstract

Insulin resistance and hyperglycemia are common in critically ill patients in the intensive care unit (ICU). Single-center studies initially showed impressive benefits to intensive control of serum glucose levels, but this benefit has failed to be replicated in most larger trials. The increased incidence of hypoglycemia in the intensive control arms of these trials may have contributed to lack of benefit. Hypoglycemia itself is an independent risk factor for ICU mortality. Most specialty societies recommend maintaining serum glucose between 140 and 180 mg/dl in critically ill patients. Samples obtained from capillaries and those analyzed on hand-held point of care monitors are less accurate than centrally obtained samples. The development of continuous glucose monitoring and closed-loop delivery systems may eventually decrease the nursing workload associated with intensive glucose control.

Keywords

Insulin Glucose Intensive care unit (ICU) Hyperglycemia 

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Authors and Affiliations

  • Richard N. Lesperance
    • 1
  • Oscar D. Guillamondegui
    • 1
  1. 1.Department of SurgeryVanderbilt University Medical CenterNashvilleUSA

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