Glycemic Control in Critically Ill Surgical Patients
Alterations in glucose production, distribution, and utilization are frequently observed in critical illness. Whether these alterations are a cause or consequence of illness, beneficial or detrimental to recovery, remains to be fully understood. It will be the focus of this chapter to provide an evidence-based, formulaic approach to insulin therapy that proactively incorporates each patient’s baseline state of health as well the expected evolution of their acute disease process and therapeutic needs. The chapter will provide methods for the reactive, fine-tuning of blood glucose management that utilizes information derived from the early stages of glucose control while transitioning to more reliable, less labor-intensive insulin regimens. Lastly, it will provide a method for dealing with the complications of glycemic control that result in dangerous levels of hyper- and hypoglycemia.
KeywordsGlycemic control Acute dysglycemia Hyperglycemia Hypoglycemia Glycemic variability Insulin therapy Insulin sensitivity
- 14.Food and Drug Aministration U.S. Department of health and human services, blood glucose monitoring test systems for presciption point-of-care use, Guidance for Industry and Food and Drug Administration Staff. Rockville; 2016.Google Scholar
- 15.Food and Drug Administration. FDA clears glucose monitoring system for use in hospital critical care units. 2014. https://wayback.archive-it.org/7993/2016022101309/fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm416144.htm . Accessed 04 Nov 2017.
- 16.Breuker C, Abraham O, di Trapanie L, Mura T, Macioce V, Boegner C, Jalabert A, Villiet M, Castet-Nicolas A, Avignon A, Sultan A. Patients with diabetes are at high risk of serious medication errors at hospital: interest of clinical pharmacist intervention to improve healthcare. Eur J Intern Med. 2016. doi: https://doi.org/10.1016/j.ejim.2016.12.003.CrossRefPubMedGoogle Scholar
- 17.(ISMP). IfSMP (Accessed January 13, 2017.) ISMP list of high-alert medications in acute care settings. Available at http://www.ismporg/Tools/highalertmedicationspdf.
- 21.Eppenga WL, Lalmohamed A, Geerts AF, Derijks HJ, Wensing M, Egberts A, et al. Risk of lactic acidosis or elevated lactate concentrations in metformin users with renal impairment: a population-based cohort study. Diabetes Care. 2014;37(8):2218–24. https://doi.org/10.2337/dc13-3023.CrossRefPubMedGoogle Scholar