Higher insulin infusion rate but not 24-h insulin consumption is associated with hypoglycemia in critically ill patients

2015 ◽  
Vol 110 (3) ◽  
pp. 322-327
Author(s):  
John J. Radosevich ◽  
Asad E. Patanwala ◽  
Paul D. Frey ◽  
Yong G. Lee ◽  
Holly Paddock ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Infusion Rate ◽  
Insulin Infusion ◽  
Insulin Infusion Rate

Guideline-Concordant Insulin Infusion Initiation Among Critically Ill Patients With Sepsis

2021 ◽  
Author(s):  
Nicholas A. Bosch ◽  
Kathryn L. Fantasia ◽  
Katherine L. Modzelewski ◽  
Sara M. Alexanian ◽  
Allan J. Walkey
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Insulin Infusion

scholarly journals Use of a Low-Molecular-Weight Heparinoid (Danaparoid Sodium) for Continuous Renal Replacement Therapy in Intensive Care Patients

2001 ◽  
Vol 7 (4) ◽  
pp. 300-304 ◽  
Author(s):  
Edelgard Lindhoff-Last ◽  
Christoph Betz ◽  
Rupen Bauersachs
Keyword(s):  
Renal Failure ◽  
Acute Renal Failure ◽  
Intensive Care ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Infusion Rate ◽  
Efficient Treatment ◽  
Intensive Care Patients

The purpose of this study was to evaluate the efficacy and safety of danaparoid in the treatment of critically ill patients with acute renal failure and suspected heparin-induced thrombocytopenia (HIT) needing renal replacement therapy (RRT). We conducted a retrospective analysis of 13 consecutive intensive care patients with acute renal failure and suspected HIT who were treated with danaparoid for at least 3 days during RRT. In eight patients, continuous venovenous hemofiltration was performed. The mean infusion rate of danaparoid was 140 ± 86 U/hour. Filter exchange was necessary every 37.5 hours. In five patients, continuous venovenous hemodialysis was used. A bolus injection of 750 U danaparoid was followed by a mean infusion rate of 138 ± 122 U/hour. Filters were exchanged every 24 hours. In 7 of 13 patients, even a low mean infusion rate of 88 ± 35 U/hour was efficient. Mean anti-Xa (aXa) levels were approximately 0.4 ± 0.2 aXa U/mL. Persistent thrombocytopenia despite discontinuation of heparin treatment was observed in 9 of 13 patients, owing to disseminated intravascular coagulation (DIC). HIT was confirmed by an increase in platelet count and positive heparin-induced antibodies in 2 of 13 patients. No thromboembolic complications occurred, but major bleeding was observed in 6 of 13 patients, which could be explained by consumption of coagulation factors and platelets due to DIC in 5 of 6 patients. Nine of 13 patients died of multiorgan failure or sepsis, or both. In none of these patients was the fatal outcome related to danaparoid treatment. In critically ill patients with renal impairment and suspected HIT, a bralus injection of 750 U danaparoid followed by a mean infusion rate of 50 to 150 U/hour appears to be a safe and efficient treatment option when alternative anticoagutation is necessary.

Changes in insulin action and GLUT-4 with 6 days of inactivity in endurance runners

1996 ◽  
Vol 80 (1) ◽  
pp. 240-244 ◽  
Author(s):  
M. D. Vukovich ◽  
P. J. Arciero ◽  
W. M. Kohrt ◽  
S. B. Racette ◽  
P. A. Hansen ◽  
...  
Keyword(s):  
Infusion Rate ◽  
Insulin Action ◽  
Insulin Infusion ◽  
Glucose Disposal ◽  
Inactive State ◽  
Transporter Protein ◽  
Glut 4 ◽  
Insulin Infusion Rate ◽  
Endurance Runners ◽  
Trained Runners

The purpose of this investigation was to determine whether decreased insulin action after 6 days of inactivity in endurance-trained runners was associated with a decrease in skeletal muscle glucose transporter protein levels (GLUT-4) in the gastrocnemius muscle. Seven endurance runners (5 men and 2 women) volunteered to participate in this investigation. All subjects had normal glucose tolerance as determined by the National Diabetes Data Group guidelines. Each individual completed two hyperinsulinemic euglycemic clamps at insulin infusion rates of 15 (LO) and 40 (HI) mU.m-2.min-1, one approximately 18 h after a training bout and the second after 6 days of inactivity (IA). Muscle biopsies for the measurement of GLUT-4 were obtained from the gastrocnemius before each clamp. Glucose disposal rates during the last 30 min of each insulin infusion were significantly reduced after 6 days of IA, averaging 6.45 +/- 1.04 mg.kg fat-free mass (FFM)-1.min-1 before and 4.55 +/- 0.56 mg.kg FFM-1.min-1 after detraining for the LO insulin infusion rate and 13.77 +/- 0.88 mg.kg FFM-1.min-1 before and 11.81 +/- 0.60 mg.kg FFM-1.min-1 after detraining for the HI insulin infusion rate (both P < 0.05), despite the fact that plasma insulin was higher in the inactive state (LO, 19.2 +/- 0.9 microU/ml before and 23.4 +/- 1.5 microU/ml after detraining; HI, 56.0 +/- 2.0 microU/ml before and 61.6 +/- 1.6 microU/ml after detraining; P < 0.05)). Calculated insulin clearance was greater in the trained than in the inactive state (P < 0.03). Muscle GLUT-4 transporter protein after 6 days of IA was reduced by 17.5 +/- 5.4% (P < 0.02). These results demonstrate that 6 days of IA reduces insulin action in endurance-trained runners and suggest that a reduction in muscle GLUT-4 transporter level plays a role in the decrease in glucose disposal rates.

scholarly journals Understanding safety differently: developing a model of resilience in the use of intravenous insulin infusions in hospital in-patients—a feasibility study protocol

BMJ Open ◽  
2019 ◽  
Vol 9 (7) ◽  
pp. e029997
Author(s):  
Mais Hasan Iflaifel ◽  
Rosemary Lim ◽  
Kath Ryan ◽  
Clare Crowley ◽  
Rick Iedema
Keyword(s):  
Blood Glucose ◽  
Phase I ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Insulin Infusion ◽  
University Hospitals ◽  
Glucose Levels ◽  
Oxford University ◽  
Intravenous Insulin ◽  
Blood Glucose Levels

BackgroundIntravenous insulin infusions are considered the treatment of choice for critically ill patients and non-critically ill patients with persistent raised blood glucose who are unable to eat, to achieve optimal blood glucose levels. The benefits of using intravenous insulin infusions as well as the problems experienced are well described in the scientific literature. Traditional approaches for improving patient safety have focused on identifying errors, understanding their causes and designing solutions to prevent them. Such approaches do not take into account the complex nature of healthcare systems, which cannot be controlled solely by following standards. An emerging approach called Resilient Healthcare proposes that, to improve safety, it is necessary to focus on how work can be performed successfully as well as how work has failed.Methods and analysisThe study will be conducted at Oxford University Hospitals NHS Foundation Trust and will involve three phases. Phase I: explore how work is imagined by analysing intravenous insulin infusion guidelines and conducting focus group discussions with guidelines developers, managers and healthcare practitioners. Phase II: explore the interplay between how work is imagined and how work is performed using mixed methods. Quantitative data will include blood glucose levels, insulin infusion rates, number of hypoglycaemic and hyperglycaemic events from patients’ electronic records. Qualitative data will include video reflexive ethnography: video recording healthcare practitioners using intravenous insulin infusions and then conducting reflexive meetings with them to discuss selected video footage. Phase III: compare findings from phase I and phase II to develop a model for using intravenous insulin infusions.Ethics and disseminationEthical approvals have been granted by the South Central—Oxford C Research Ethics Committee, Oxford University Hospitals NHS Foundation Trust and University of Reading. The results will be disseminated through presentations at appropriate conferences and meetings, and publications in peer-reviewed journals.

Insulin and oral anti-hyperglycaemic agents in critical illness

2016 ◽  
Author(s):  
Roosmarijn T. M. van Hooijdonk ◽  
Marcus J. Schultz
Keyword(s):  
Blood Glucose ◽  
Critical Illness ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Insulin Infusion ◽  
Venous Catheter ◽  
Glycaemic Variability ◽  
Mortality And Morbidity ◽  
Glucose Levels ◽  
Measuring Devices

Dysglycaemia is frequently seen in the intensive care unit (ICU). Hyperglycaemia, hypoglycaemia and glycaemic variability are all independently associated with mortality and morbidity in critically-ill patients. It is common practice to treat hypergycaemia in these patients, while at the same time preventing hypoglycaemia and glycaemic variability. Insulin infusion is preferred over oral anti–hyperglycaemic agents for glucose control in the ICU because of the highly unpredictable biological availability of oral anti-hyperglycaemic agents during critical illness. Many oral anti–hyperglycaemic agents are relatively contraindicated in critically-ill patients. Intravenously-administered insulin has a predictable effect on blood glucose levels, in particular because of its short half-life. Notably, effective and safe insulin titration requires frequent blood glucose measurements, a dedicated lumen of a central venous catheter for infusion of insulin, an accurate syringe pump, and trained nurses for delicate adoptions of the infusion rate. Insulin infusion increases the risk of hypoglycaemia, which should be prevented at all times. In addition, precautions should be taken against overcorrection of hypoglycaemia, using only small amounts of glucose. Whether glycaemic variability can be kept minimal is uncertain. Use of continuous glucose measuring devices has the potential to improve glycaemic control in critically-ill patients.

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