Intravenous insulin infusion therapy: indications, methods, and transition to subcutaneous insulin therapy.

Endocrine Practice : Official Journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists
Bruce W BodePaul C Davidson

Abstract

To describe indications for intravenous (IV) insulin infusion therapy and glycemic thresholds, discuss methods and protocols, and promote use of and access to IV insulin infusion therapy for all appropriate patients in the hospital setting. Randomized, prospectively designed trials support the use of IV insulin infusion therapy for patients in the surgical intensive-care unit, including postoperative cardiac patients and patients having myocardial infarction. Among patients in the surgical intensive-care unit, reanalysis of the data suggested no threshold at which benefit occurred above the blood glucose level of 110 mg/dL. In another study, retrospective analysis of data among critically ill medical and surgical patients suggested a target blood glucose level of 145 mg/dL or less. In other populations, the threshold or ideal target blood glucose range has not been determined. Three protocols for IV insulin infusion are described that maintain blood glucose levels safely below the upper limit of their respective target ranges without substantial risk of hypoglycemia. The threshold for initiation of IV insulin infusion is 110 mg/dL for critically ill surgical patients, 140 mg/dL for other medical or surgical patients, 180 mg/dL ...Continue Reading

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