Related Experiment Video

Updated: Jun 28, 2026

Improving IV Insulin Administration in a Community Hospital
12:08

Improving IV Insulin Administration in a Community Hospital

Published on: June 11, 2012

Glycemic control in the ICU

Grant V Bochicchio1, Thomas M Scalea

  • 1University of Maryland School of Medicine, Room T1R59, R Adams Cowley Shock Trauma Center, 22 South Greene Street, Baltimore, MD 21201, USA. gbochicchio@umm.edu

Advances in Surgery
|October 29, 2008
PubMed

Insights

Achieving tight glycemic control improves outcomes for critically ill patients. Continuous glucose monitoring may offer a solution to balance benefits and hypoglycemia risks in intensive care units.

Area of Science:

  • Critical Care Medicine
  • Endocrinology
  • Medical Technology

Background:

  • Glycemic control is crucial for improving outcomes in critically ill patients.
  • Optimal glycemic targets and patient acuity levels for demonstrating clinical benefit remain unclear.
  • Short ICU stays (≤3 days) may hinder the visualization of clinical benefits.

Purpose of the Study:

  • To explore the optimal glycemic control range for critically ill patients.
  • To determine if clinical benefits are specific to higher acuity patients.
  • To identify methods for achieving target glycemic control without increasing hypoglycemia risk.

Main Methods:

  • The study discusses the challenges in demonstrating clinical benefits in trials with short ICU stays.
  • It posits that benefits are more evident in higher acuity patients with longer ICU stays related to inflammatory response reversal.
  • The potential of continuous glucose monitoring (CGM) technology is highlighted.

Main Results:

  • Clinical benefits of glycemic control are more apparent in higher acuity patients.
  • Achieving target glycemic control (80-110 mg/dL) without hypoglycemia is a significant challenge.
  • Continuous glucose monitors offer a promising solution for precise and efficient glucose monitoring.

Conclusions:

  • Glycemic control is vital for critically ill patients, particularly those with higher acuity.
  • Continuous glucose monitoring devices are anticipated to facilitate safer and more effective glycemic management.
  • Future advancements in technology may resolve current challenges in achieving optimal glycemic control.

Related Concept Videos

Hypoglycemia and Glucagon01:15

Hypoglycemia 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...
Diabetes: Management and Pharmacotherapy01:15

Diabetes: 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...
Diabetic Ketoacidosis l: Introduction01:25

Diabetic Ketoacidosis l: Introduction

DefinitionDiabetic ketoacidosis (DKA) is an acute, life-threatening complication of diabetes mellitus, characterized by a triad of hyperglycemia (blood glucose >250 mg/dL), ketonemia or ketonuria, and metabolic acidosis (arterial pH <7.30 and serum bicarbonate <18 mEq/L). It results from insulin deficiency combined with elevated levels of counterregulatory hormones—glucagon, catecholamines, cortisol, and growth hormone—leading to increased lipolysis, hepatic ketone production, and...
Hyperglycemia01:29

Hyperglycemia

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...
Oral Hypoglycemic Agents: &#945;-Glucosidase Inhibitors01:19

Oral Hypoglycemic Agents: α-Glucosidase Inhibitors

α-glucosidase inhibitors, including acarbose (Precose), miglitol (Glyset), and voglibose (Voglib) (primarily available in Asia), are drugs that control blood sugar levels by delaying the digestion of starch and disaccharides. They achieve this by inhibiting α-glucosidase enzymes in the intestine, which slow the absorption of carbohydrates in the intestine, which in turn leads to a prolonged release of the glucoregulatory hormone GLP-1 from intestinal L-cells.
Acarbose and miglitol are typically...
Insulin: Dosing Regimen and Adverse Effects01:16

Insulin: 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...