Related Experiment Video
Updated: Jun 8, 2026
12:08
Improving IV Insulin Administration in a Community Hospital
Published on: June 11, 2012
Tight glycemic control: what do we really know, and what should we expect?
Stanley A Nasraway1, Rishi Rattan
1Department of Surgery, Tufts Medical Center, 750 Washington Street, Box 4630, Boston, MA 02111, USA. snasraway@tuftsmedicalcenter.org
Critical Care (London, England)
|September 30, 2010
Summary
Intensive insulin therapy for tight glycemic control yields conflicting results despite widespread use. This review clarifies current certainties and future expectations in glucose management practices.
Area of Science:
- Endocrinology
- Metabolic Disorders
- Clinical Research
Background:
- Extensive research exists on tight glycemic control, yet findings remain conflicting.
- Intensive insulin therapy is widely adopted but implemented with significant variability in glucose monitoring and control methods.
Discussion:
- This commentary critically evaluates the established knowledge from numerous studies on intensive glycemic control.
- It addresses the inconsistencies in research outcomes and practical application of insulin therapy.
Key Insights:
- Certainty regarding the precise benefits and risks of tight glycemic control remains limited due to conflicting data.
- Variability in glucose measurement and control strategies complicates the interpretation of study results.
Outlook:
- Future research should focus on standardizing methodologies for glucose control and measurement.
- Clarifying the optimal application of intensive insulin therapy is crucial for improving patient outcomes.
Related Concept Videos
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...
01:15Hypoglycemia 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...
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...
01:22Diabetes Mellitus: Type 2 and Gestational
Type 2 diabetes, characterized by insulin resistance, arises when the insulin receptors on cells lose responsiveness to insulin, diminishing the cell's capacity to take up glucose, resulting in elevated blood glucose levels. To receive a diagnosis of Type 2 diabetes, a series of blood glucose tests are necessary to assess whether the blood glucose falls within normal parameters. If the result is out of the normal range, a patient may be diagnosed as prediabetic or diabetic, depending on the...
01:02Glucose Homeostasis: Regulation of Blood Glucose
Carbohydrates consumed through foods are converted into glucose, a crucial energy source for the body. In the prandial state, high blood glucose levels stimulate the secretion of insulin from the pancreas. Insulin inhibits hepatic glucose production and stimulates glucose uptake and metabolism by muscle and adipose tissue. The excess glucose is converted into glycogen and stored in the liver and muscles.
During fasting, when blood glucose levels are low, the pancreas secretes glucagon. it...
During fasting, when blood glucose levels are low, the pancreas secretes glucagon. it...
01:26Hypoglycemia
Hypoglycemia is a blood glucose level below 70 mg/dL. It commonly occurs in individuals using insulin or insulin-secreting drugs, but may also arise in non-diabetic conditions. People with type 1 diabetes are at the highest risk because they depend on exogenous insulin. People with type 2 diabetes are also at risk, especially when treated with insulin or medications such as sulfonylureas, which increase insulin release regardless of blood glucose levels. It develops when insulin levels exceed...