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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...
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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.
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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...
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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...
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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.
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Glycemic control in critically ill: A moving target.

Subhash Todi1

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Indian Journal of Critical Care Medicine : Peer-Reviewed, Official Publication of Indian Society of Critical Care Medicine
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Summary

Effective glycemic control in intensive care units (ICUs) requires avoiding hyperglycemia and hypoglycemia. Glycemic variability also poses risks, necessitating protocols that manage all three domains for better patient outcomes.

Keywords:
Diabetesglycemic variabilityhyperglycemiahypoglycemiaintensive care unit

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Area of Science:

  • Critical Care Medicine
  • Endocrinology
  • Metabolic Disorders

Background:

  • Glycemic control in intensive care units (ICUs) is complex, involving multiple patient factors.
  • Hyperglycemia, hypoglycemia, and glycemic variability present distinct challenges in critically ill patients.

Purpose of the Study:

  • To outline the key domains of glycemic control in ICUs.
  • To discuss the implications of patient population and diabetic status on glycemic targets.
  • To highlight the detrimental effects of hypoglycemia and glycemic variability.

Main Methods:

  • Review of existing literature on glycemic control in ICUs.
  • Analysis of patient populations, including surgical and medically ill patients.
  • Consideration of diabetic status and its influence on glycemic tolerance.

Main Results:

  • Excessive hyperglycemia should be avoided, with upper limits varying by patient type and diabetic status.
  • Hypoglycemia is detrimental across all critically ill patient groups and must be prevented.
  • Glycemic variability is increasingly recognized as harmful and requires targeted reduction.

Conclusions:

  • Glycemic control protocols must address hyperglycemia, hypoglycemia, and variability.
  • Patient-specific factors influence optimal glycemic targets.
  • Emerging technologies like continuous glucose monitoring can aid in managing these three domains.