Related Experiment Video
Updated: Jul 15, 2026
12:08
Improving IV Insulin Administration in a Community Hospital
Published on: June 11, 2012
Intensive insulin therapy for acute hyperglycemia.
Julia Lindeman Read1, Eugene Y Cheng
1Risk and Patient Safety, Kaiser Permanente, Fremont Medical Center, 39400 Paseo Padre Pkwy, Freemont, CA 94538, USA. Julie.Read@kp.org
AACN Advanced Critical Care
|May 3, 2007
Summary
Controlling high blood sugar (hyperglycemia) in critically ill patients improves outcomes and reduces complications. Implementing intensive insulin therapy protocols is key to achieving this tight glycemic control.
Area of Science:
- Critical Care Medicine
- Endocrinology
- Clinical Research
Background:
- Hyperglycemia is common in critically ill patients.
- Elevated blood glucose levels are associated with increased risks of sepsis, organ damage, and mortality.
- Effective management strategies are crucial for improving patient outcomes.
Purpose of the Study:
- To review the evidence supporting glycemic control in critical care.
- To discuss the impact of hyperglycemia on patient outcomes.
- To detail the implementation of intensive insulin therapy protocols.
Main Methods:
- Literature review of current and benchmark research.
- Analysis of the effects of hyperglycemia.
- Description of intensive insulin therapy protocols.
Main Results:
- Evidence supports that controlling hyperglycemia improves outcomes in critically ill patients.
- Glycemic control reduces the incidence of sepsis, end-organ damage, and hospital mortality.
- Intensive insulin therapy is an effective method for managing acute hyperglycemia.
Conclusions:
- Tight glycemic control is essential for critically ill patients.
- Clinicians should be familiar with evidence-based practices for hyperglycemia management.
- Implementation of intensive insulin therapy protocols can decrease patient complications.
Related Concept Videos
01:16Insulin: Dosing Regimen and Adverse Effects
Insulin-replacement therapy usually includes both long-acting insulin (basal) and short-acting insulin (to cater to postprandial needs). In a diverse group of type 1 diabetes patients, the average daily insulin dose is typically 0.5-0.7 units/kg body weight. However, obese patients and pubertal adolescents may need more due to insulin resistance.
The basal dose constitutes about 40%-50% of the total daily dose, with the rest as premeal insulin. The mealtime insulin dose should mirror...
The basal dose constitutes about 40%-50% of the total daily dose, with the rest as premeal insulin. The mealtime insulin dose should mirror...
01:27Insulin Formulations: Types and Delivery
Insulin preparations are categorized by their duration of action into short-acting and long-acting types. Two strategies are used to modify insulin's absorption and pharmacokinetic profile: slowing the absorption post-subcutaneous injection, or altering human insulin's amino acid sequence or protein structure. These changes retain the insulin's ability to bind to the insulin receptor, but alter its behavior in solution or after injection.
Short-acting insulins are divided into rapid-acting...
Short-acting insulins are divided into rapid-acting...
01:29Hyperglycemia
Hyperglycemia is an abnormally high blood glucose level. It is diagnosed by fasting glucose ≥126 mg/dL, 2-hour oral glucose tolerance test (or OGTT) ≥200 mg/dL, random glucose ≥200 mg/dL with symptoms, or HbA1c ≥6.5%. However, HbA1c results may be unreliable in certain conditions, such as anemia or hemoglobinopathies, and the diagnosis should be confirmed unless classic symptoms are present. Postprandial hyperglycemia is typically considered significant when glucose levels exceed 180 mg/dL two...
01:15Diabetes: Management and Pharmacotherapy
The therapy for diabetes aims to alleviate hyperglycemia-related symptoms, prevent acute metabolic decompensation, and reduce chronic end-organ complications. Glycemic control is evaluated through short-term (self-monitoring, continuous glucose monitoring) and long-term (A1c, fructosamine) metrics, enabling near real-time tracking of blood glucose levels and reflecting glycemic control over specific time frames.
Insulin remains the cornerstone of treatment for most patients with type 1 and many...
Insulin remains the cornerstone of treatment for most patients with type 1 and many...
01:06Oral Hypoglycemic Agents: Glinides
Repaglinide (Prandin) and Nateglinide (Starlix), known as glinides, are oral insulin secretagogues that stimulate insulin release from pancreatic β cells by closing the ATP-sensitive potassium channels (KATP channel). Repaglinide controls insulin release from pancreatic β cells by managing potassium efflux. It shares two binding sites with sulfonylureas and also has a unique site, indicating overlapping mechanisms of action. With a rapid onset and a 4-7 hour duration, it effectively manages...
01:15Hypoglycemia and Glucagon
Without prolonged fasting, healthy individuals maintain blood glucose levels above 3.5 mM due to a well-adapted neuroendocrine counterregulatory system that effectively prevents acute hypoglycemia, a potentially life-threatening condition. The primary clinical scenarios for hypoglycemia encompass diabetes treatment, inappropriate production of endogenous insulin or insulin-like substances by tumors, and the use of glucose-lowering agents in non-diabetic individuals. Notably, hypoglycemia in the...