An improved method for blood glucose control during nutritional support

Hyperglycemia may be a considerable problem in ill patients receiving nutritional support. In these patients, the traditional 4- to 6-hourly urine sliding scale responds too slowly to changes in blood glucose, and marked hyperglycemia can occur. Regular bedside measurement of blood glucose makes control easier, but if insulin requirements change, the scale of doses must be reassessed and rewritten frequently. The problems may be overcome by the use of a scale of instructions for changing the rate of intravenous infusion from a syringe pump and the insulin concentration in the syringe. The same scale applies at all blood glucose levels and insulin doses. This method has been used in patients at risk from hyperglycemia on the Intensive Care Unit for over a year and has proved remarkably successful. Thirty-nine such patients had their blood glucose concentrations stabilized within a median time of 9 hours. In some patients, high doses of insulin were necessary, but no dangerous hyper- or hypoglycemia has occurred. A simple modification which improves safety without loss of good control has recently been included and used without difficulty in a further 12 patients.