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Ultradian Variation of Blood Glucose in Intensive Care Unit Patients Receiving Insulin Infusions

¹ Pulmonary and Critical Care Medicine, Oregon Health and Science University, Portland, Oregon
² Center for Intensive Care Research, Oregon Health and Science University, Portland, Oregon
³ Physiology and Pharmacology, Oregon Health and Science University, Portland, Oregon
⁴ Care Management, Oregon Health and Science University, Portland, Oregon
⁵ Pharmacy Services, Oregon Health and Science University, Portland, Oregon
⁶ Division of Endocrinology, Oregon Health and Science University, Portland, Oregon

Address correspondence and reprint requests to Stephen M. Smith, Pulmonary and Critical Care Medicine, Biomedical Research Building (UHN-67), 3181 SW Sam Jackson Park Rd., Oregon Health and Science University, Portland, OR 97239-3098. E-mail: smisteph@ohsu.edu

Abbreviations: IIP, insulin infusion protocol • ICU, intensive care unit

The first 300 words of the full text of this article appear below.

	INTRODUCTION

 
Treatment of hyperglycemia with an insulin infusion protocol (IIP) has improved outcomes in intensive care unit (ICU) patients (1,2). While morning glucose has been reported, little is known about variation of blood glucose for patients on IIP, causing uncertainty about the optimal treatment of ICU patients (3–5). Our objectives were to test whether morning glucose represented whole-day glucose and to determine whether glucose varied over the course of the day. In ICU patients receiving IIP, glucose was lower in the early morning, correlated poorly with average glucose, and varied with an ultradian pattern.

	RESEARCH DESIGN AND METHODS—

 
In this prospective, single-center, observational study in the ICUs of a university tertiary care hospital, we recorded all glucose measurements in two cohorts of ICU patients receiving an IIP targeting blood glucose 80–110 mg/dl. Supplementary details are available in an online appendix (available at http://dx.doi.org/10.2337/dc07-0865.).

	RESULTS—

 
Between 20 May 2006 and 6 August 2006, 141 ICU patients were treated with IIP, 8 of whom received insulin for two periods, resulting in 149 patient episodes. The average duration of insulin use for an episode was 115 ± 9 h (range 5–604). Forty-one percent (n = 11,670) of glucose measurements during this period were in the target range (80–110 mg/dl) (Fig. 1A). In preliminary data acquired between May 2004 and June 2005, the proportion of measurements in the target range increased initially and then stabilized (Fig. 1). Twenty-six percent of patients experienced at least one glucose value <60 mg/dl, and 2.7% had a glucose value <40 mg/dl.

View larger version (48K):   Figure 1— Blood glucose variation in ICU patients receiving IIP. A: Category plot of the percentage of measurements in described blood glucose ranges in ICU patients receiving IIP for hyperglycemia. The measurements (n = 655, 1,374, 2,508, 1,547, . . . [Full Text of this Article]

	CONCLUSIONS—

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				S. M. Smith and D. S. Hagg Glucose Variance in ICU Patients Receiving Insulin Infusions Chest, May 1, 2008; 133(5): 1288 - 1288. [Full Text] [PDF]