Glucose control in critical illness using a web-based insulin dose calculator

Area of Science:

• Critical Care Medicine
• Endocrinology
• Medical Informatics

Background:

• Effective blood glucose management is crucial in intensive care units (ICUs).
• Traditional methods for insulin dosing can be complex and time-consuming.
• Web-based tools offer potential for improved efficiency and accuracy in critical care.

Purpose of the Study:

• To describe a modified web-based insulin calculator for critical care blood glucose control.
• To evaluate the calculator's utility and impact on blood glucose monitoring.
• To assess blood glucose patterns under modified feeding and insulin protocols.

Main Methods:

• A previously developed web-based insulin calculator was modified to include bolus insulin doses.
• The enhanced calculator stores patient data, including blood glucose, insulin rates, and timestamps.
• Feeding protocols were adjusted, and a 16-bedded ICU population (June 2005-May 2006) was studied.

Main Results:

• The study included 661 patients with a mean APACHE II score of 16.
• A total of 13,029 data points were recorded over 5,573 patient days.
• Mean blood glucose was 6.7 mmol/L, with 34 episodes of treated hypoglycemia; no diurnal variation was observed.

Conclusions:

• The modified web-based insulin calculator effectively facilitates insulin dosing in critical care.
• The absence of diurnal blood glucose variation suggests that once-daily monitoring may be adequate.
• This approach can streamline glucose management and potentially reduce monitoring frequency.