Cleveland Clinic cardiovascular intensive care unit insulin conversion protocol

Area of Science:

• Endocrinology
• Cardiothoracic Surgery
• Pharmacology

Background:

• Maintaining near-normal blood glucose is crucial post-cardiac surgery.
• Intravenous insulin infusion in an intensive care unit (ICU) setting is standard but resource-intensive.
• Glucose management protocols after ICU transfer to a regular nursing floor (RNF) lack systematic study.

Purpose of the Study:

• To evaluate the safety and efficacy of transitioning patients from intravenous insulin infusion to subcutaneous insulin glargine.
• To assess a protocol involving 50% of the calculated 24-hour insulin requirement as subcutaneous insulin glargine upon ICU discharge.

Main Methods:

• Prospective analysis of patients undergoing cardiothoracic surgery and receiving intravenous insulin infusion.
• Examination of a protocol transitioning patients to subcutaneous insulin glargine (50% of 24-hour requirement) before RNF transfer.

Main Results:

• Only 1 out of 99 patients experienced hypoglycemia; no severe hypoglycemia was recorded.
• Seventy percent of patients achieved euglycemia (blood glucose 70-150 mg/dL).

Conclusions:

• The transition protocol using insulin glargine is safe, with minimal hypoglycemia.
• The protocol is effective, achieving euglycemia in the majority of patients.
• Efficacy may be limited by dosage caps on insulin glargine, necessitating careful provider override consideration for high-need patients.