Related Experiment Video

Updated: May 30, 2026

Improving IV Insulin Administration in a Community Hospital
12:08

Improving IV Insulin Administration in a Community Hospital

Published on: June 11, 2012

How low should you go? The limbo of glycemic control in intensive care units

Andrew C Faust1, Rebecca L Attridge, Laurajo Ryan

  • 1Methodist University Hospital, Dept of Pharmacy, Memphis, TN 38104, USA. rphfaust@gmail.com

Critical Care Nurse
|August 3, 2011
PubMed

Insights

Intensive insulin therapy for critically ill patients showed initial promise but later studies revealed increased mortality and hypoglycemia. Current guidelines suggest alternative blood glucose targets for better patient outcomes.

Area of Science:

  • Critical care medicine
  • Endocrinology
  • Clinical research

Background:

  • Hyperglycemia is common in critically ill patients and associated with adverse outcomes.
  • The initial Leuven I study (2001) suggested intensive insulin therapy reduced mortality in surgical ICUs.
  • Subsequent studies yielded mixed results, with some showing no significant mortality benefit.

Purpose of the Study:

  • To evaluate the efficacy and safety of intensive insulin therapy in critically ill patients.
  • To determine if the initial benefits observed in the Leuven I study are reproducible.
  • To assess the risk of hypoglycemia associated with intensive insulin therapy.

Main Methods:

  • Review of key clinical trials evaluating intensive insulin therapy in critically ill populations.
  • Comparison of mortality rates and hypoglycemia incidence between intensive insulin therapy and conventional glucose control.
  • Analysis of data from single-center, medical ICU, and multicenter studies.

Main Results:

  • The initial Leuven I study reported a 3.4% absolute mortality reduction.
  • Subsequent studies, including multicenter trials, showed no significant mortality benefit.
  • Some studies were halted early due to significantly higher rates of hypoglycemia with intensive insulin therapy, which was linked to increased mortality.
  • The largest prospective study found significantly higher mortality in the intensive therapy group (27.5%) versus control (24.9%).

Conclusions:

  • Intensive insulin therapy does not consistently benefit all critically ill patients.
  • The risk of hypoglycemia and associated increased mortality must be considered.
  • Alternative blood glucose targets (e.g., 140-180 mg/dL) are proposed to balance glycemic control and safety.

More Related Videos

Hyperglycemic Clamp and Hypoglycemic Clamp in Conscious Mice07:35

Hyperglycemic Clamp and Hypoglycemic Clamp in Conscious Mice

Published on: January 26, 2024

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...
Hypoglycemia01:26

Hypoglycemia

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...
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...
Diabetic Ketoacidosis ll: Pathophysiology01:22

Diabetic Ketoacidosis ll: Pathophysiology

Diabetic ketoacidosis (DKA) is a metabolic emergency characterized by hyperglycemia, ketonemia, and metabolic acidosis. It results from severe insulin deficiency and an excess of counterregulatory hormones, leading to uncontrolled lipolysis, ketogenesis, and widespread electrolyte and fluid disturbances.Pathophysiology The central event in DKA is a profound loss of insulin action. Without insulin, glucose uptake in insulin-dependent tissues is impaired, while hepatic glucose production...
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...
SBAR II: Application of SBAR01:14

SBAR II: Application of SBAR

SBAR is an effective communication tool used by healthcare professionals to communicate patient information accurately. SBAR stands for Situation, Background, Assessment, and Recommendation. For a better understanding, an example is given below.
SBAR Report from a Nurse to a Health Care Provider
S: "Hello, Dr. Smith. This is Jane, RN, from the Med Surg unit. I am calling to tell you about Ms. White in Room 210, who is experiencing increased pain and redness at her incision site. Her recent...