Intravenous insulin nomogram improves blood glucose control in the critically ill

Area of Science:

• Critical care medicine
• Endocrinology
• Nursing practice

Background:

• Critically ill patients often experience hyperglycemia, necessitating precise glucose management.
• Traditional methods like sliding scale insulin infusions can be suboptimal for maintaining tight glycemic control.

Purpose of the Study:

• To evaluate the effectiveness and safety of a nurse-managed, bedside intravenous insulin nomogram for improving blood glucose control in critically ill patients.

Main Methods:

• A retrospective, before-after cohort study was conducted in a mixed medical/surgical intensive care unit.
• 167 patients requiring intravenous insulin infusions were analyzed, comparing a baseline sliding scale group with an intervention group using a dosing nomogram.
• The nomogram allowed nurses to independently adjust insulin infusion rates based on glucose levels and infusion history.

Main Results:

• The median time to initial glucose control (<11.5 mmol/L) was significantly reduced in the nomogram group (2 hours) compared to the sliding scale group (4 hours) (p=.0004).
• The nomogram group also showed a significantly lower area under the curve for glucose concentrations above 11.5 mmol/L (0.3 vs. 0.9, p=.0001).
• There was no increase in hypoglycemia episodes in the nomogram group.

Conclusions:

• Implementation of a nurse-managed intravenous insulin nomogram effectively improves glycemic control in critically ill patients.
• The nomogram represents a safe and efficient tool for managing blood glucose concentrations in the intensive care unit setting.