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Glucometrics and Measuring Blood Glucose in Critically Ill Patients

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Monitoring Technologies in Acute Care Environments

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Abstract

Glucose homeostasis is dysregulated in critical illness, and “stress hyperglycemia” carries significant morbidity and is an independent risk factor for poor outcome after ICU admission. Clinicians, various regulatory organizations, and clinical societies have therefore drafted guidelines for the management of hyperglycemia in the critically ill. The institution of “tight glycemic control” utilizing insulin infusions to achieve blood glucose levels of 80–110 mg/dl was widely accepted following the publication of improved outcomes in critically ill patients in the initial Van den Berghe study in 2001. Many studies following, however, were unable to reproduce the outcomes realized in the first study and raised concern regarding increased frequency of hypoglycemia on intensive insulin therapy regimens. The purpose of this chapter is to evaluate the various methodologies utilized in ICUs to measure glucose levels that are then used to make treatment decisions regarding management of the hyperglycemia of critical illness. A comparison of point-of-care (POC) testing with glucose meters, arterial blood gas (ABG) measurements, and central laboratory (CLM) testing is explored with a focus on how measurements are made, accuracy, cost, and convenience.

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Author information

Authors and Affiliations

  1. Division of Anesthesiology-Critical Care Medicine, Department of Anesthesiology, Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, TN, 37323, USA

    Gregory E. Evans MD

  2. Division of Anesthesiology-Critical Care Medicine, Department of Anesthesiology, Vanderbilt University Medical Center, 1211 21st Avenue South, Medical Arts Building Suite 526, Nashville, TN, 37212, USA

    Donald Crabtree DO

  3. Division of Anesthesiology-Critical Care Medicine, Department of Anesthesiology, Vanderbilt University Medical Center, 1211 21st Avenue South, Nashville, TN, 37212, USA

    Liza M. Weavind MBBCh, FCCM

Authors
  1. Gregory E. Evans MD
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  2. Donald Crabtree DO
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  3. Liza M. Weavind MBBCh, FCCM
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Corresponding author

Correspondence to Liza M. Weavind MBBCh, FCCM .

Editor information

Editors and Affiliations

  1. Departments of Anesthesiology, Surgery, and Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA

    Jesse M. Ehrenfeld

  2. Department of Anesthesiology and Perioperative Care, University of California, Irvine, Irvine, California, USA

    Maxime Cannesson

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Evans, G.E., Crabtree, D., Weavind, L.M. (2014). Glucometrics and Measuring Blood Glucose in Critically Ill Patients. In: Ehrenfeld, J., Cannesson, M. (eds) Monitoring Technologies in Acute Care Environments. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-8557-5_35

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  • DOI: https://doi.org/10.1007/978-1-4614-8557-5_35

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  • Online ISBN: 978-1-4614-8557-5

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