scholarly journals Comparison between Continuous Regular Insulin Infusion and Single Dose Subcutaneous Long Acting Insulin Injection in Intensive Care Unit

2021 ◽  
Vol 84 (1) ◽  
pp. 2625-2632
Author(s):  
Khaled Mohammed Hassan ◽  
Kareem Khaled Elhossini ◽  
Abd Elhady Ahmed Helmy Abd Elhady
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Single Dose ◽  
Insulin Infusion ◽  
Insulin Injection ◽  
Regular Insulin ◽  
Acting Insulin ◽  
Long Acting

scholarly journals Cleveland Clinic Cardiovascular Intensive Care Unit Insulin Conversion Protocol

2009 ◽  
Vol 3 (3) ◽  
pp. 478-486 ◽  
Author(s):  
Leann Olansky ◽  
Sharon Sam ◽  
Cheryl Lober ◽  
Jean-Pierre Yared ◽  
Byron Hoogwerf
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Insulin Glargine ◽  
Insulin Infusion ◽  
Cleveland Clinic ◽  
Severe Hypoglycemia ◽  
Perioperative Period ◽  
High Insulin ◽  
Long Acting ◽  
Insulin Infusion Protocol

Background: The importance of near-normal blood glucose in the immediate postoperative period is generally accepted and is best achieved in the perioperative period with a constant intravenous (IV) infusion of insulin. This requires intensive nursing only achievable in an intensive care unit (ICU) setting. Glucose management after transfer to a regular nursing floor (RNF) has not been studied systematically. In August 2006, the Cleveland Clinic began using long-acting insulin glargine as the insulin infusion was terminated in the ICU. Methods: This prospective analysis examined all patients receiving IV insulin infusion after cardiothoracic surgery in a 1 month period. The analyses evaluated the safety and efficacy of a protocol using a transition to subcutaneous insulin glargine of 50% of the calculated 24 h requirement at the end of the ICU insulin infusion protocol in preparation for transfer to the RNF. Results: Only 1 patient in 99 developed hypoglycemia, and no patient suffered severe hypoglycemia (glucose < 40 mg/dl), while the majority (70%) had euglycemia (glucose between 70 and 150 mg/dl). Conclusions: This approach was both safe—as there was very little hypoglycemia (1 patient in 99)—and effective, as blood sugar was well controlled in most subjects. Efficacy for achieving euglycemia was 70%. Efficacy was likely reduced because of the upper limit of insulin glargine dosage imposed by some providers as a safety consideration. Although there was a physician option to override, the maximum protocol dose of 30 U was rarely exceeded, leading to inadequate dosing in some subjects who required high insulin infusion rates in the ICU.

Association Between the Use of Long-Acting Insulin and Hypoglycemia in Nondiabetic Patients in the Surgical Intensive Care Unit

2016 ◽  
Vol 33 (5) ◽  
pp. 317-321 ◽  
Author(s):  
Jordan Masse ◽  
Christopher Alan Giuliano ◽  
Sara Brown ◽  
Renee Alexander Paxton
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
Intensive Care Patients ◽  
Acting Insulin ◽  
Sliding Scale ◽  
Order And Type ◽  
Long Acting ◽  
Critically Ill Surgical Patients

Purpose: The purpose of this study was to examine the association between long-acting insulin and hypoglycemia in nondiabetic surgical intensive care patients. Methods: This single-center, retrospective cohort study evaluated glycemic control in nondiabetic critically ill surgical patients receiving long-acting insulin plus sliding scale versus those receiving sliding scale alone. Patients were matched based on sliding scale order and type of surgery. The primary outcome was the proportion of patients who experienced hypoglycemia (glucose values <70 mg/dL). Secondary outcomes included comparing the distribution of glycemic events in the 2 groups and describing the proportion of patients transferred out of the intensive care unit on long-acting insulin who experienced hypoglycemia. Results: One hundred twenty patients met the study criteria. Hypoglycemia was significantly higher in the long-acting insulin plus sliding scale group compared to those receiving sliding scale alone (17 [28.3%] patients vs 8 [13.3%] patients; P = .047). After adjusting for body mass index, renal failure, age, and Acute Physiology and Chronic Health Evaluation II, the odds of hypoglycemia were 4.1 times higher for patients receiving long-acting insulin and sliding scale compared to those receiving sliding scale alone ( P = .02). There were more hypoglycemic events (42 vs 20; P = .05) and hyperglycemic events (313 vs 135; P = .02) in the long-acting insulin group. Conclusion: This study demonstrated higher rates of hypoglycemia associated with the utilization of long-acting insulin in nondiabetic surgical intensive care patients. Risk of hypoglycemia should be weighed against possible benefits in this population.

Insulin infusion therapy in critical care patients: Regular insulin vs short-acting insulin. A prospective, crossover, randomized, multicenter blind study

2015 ◽  
Vol 30 (2) ◽  
pp. 437.e1-437.e6 ◽  
Author(s):  
Federico Bilotta ◽  
Rafael Badenes ◽  
Simona Lolli ◽  
Francisco Javier Belda ◽  
Sharon Einav ◽  
...  
Keyword(s):  
Critical Care ◽  
Insulin Infusion ◽  
Regular Insulin ◽  
Blind Study ◽  
Infusion Therapy ◽  
Short Acting ◽  
Acting Insulin ◽  
Short Acting Insulin ◽  
Critical Care Patients

scholarly journals Different Brain Responses to Hypoglycemia Induced by Equipotent Doses of the Long-Acting Insulin Analog Detemir and Human Regular Insulin in Humans

Diabetes ◽  
2007 ◽  
Vol 57 (3) ◽  
pp. 746-756 ◽  
Author(s):  
Paolo Rossetti ◽  
Francesca Porcellati ◽  
Natalia Busciantella Ricci ◽  
Paola Candeloro ◽  
Patrizia Cioli ◽  
...  
Keyword(s):  
Regular Insulin ◽  
Insulin Analog ◽  
Acting Insulin ◽  
Brain Responses ◽  
Long Acting

Discharge prescribing of enteral opioids after initiation as a weaning strategy from continuous opioid infusions in the Intensive Care Unit

2018 ◽  
Vol 14 (1) ◽  
pp. 35 ◽  
Author(s):  
Bridgette Kram, PharmD, BCPS, BCCCP ◽  
Kylie M. Weigel, PharmD, BCPS ◽  
Michelle Kuhrt, PharmD ◽  
Daniel L. Gilstrap, MD
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Hospital Discharge ◽  
Physical Dependence ◽  
Total Duration ◽  
Opioid Therapy ◽  
Hospital Length ◽  
Patients At Risk ◽  
Long Acting ◽  
Discharge Prescription

Objective: To evaluate the proportion of patients receiving a hospital discharge prescription for a scheduled enteral opioid following initiation as a weaning strategy from a continuous opioid infusion in the Intensive Care Unit (ICU).Design: Retrospective, observational study.Setting: Five adult ICUs at a large, quaternary care academic medical center.Patients: Endotracheally intubated, opioid-naive adults receiving a continuous opioid infusion with a concomitant scheduled enteral opioid initiated. Exclusion criteria were receipt of fewer than two enteral opioid doses, documentation of a long-acting opioid as a home medication, the indication for the enteral opioid was not a weaning strategy, death during hospital admission or discharge to hospice. Interventions: None.Main outcome measures: The proportion of ICU and hospital survivors who received a discharge prescription for a scheduled enteral opioid, total duration of continuous opioid infusion, duration of continuous opioid infusion after initiation of an enteral opioid therapy, total duration of enteral therapy, ICU and hospital length of stay.Results: Of 62 included patients, 19 patients (30.6 percent) received a new prescription for a scheduled enteral opioid at hospital discharge. The median duration of enteral opioid therapy was longer for patients who received a discharge prescription compared to those who did not (20.09 vs 8.89 days, p = 0.02), though the remaining endpoints were not different.Conclusions: Utilizing scheduled enteral opioids as a weaning strategy from continuous opioid infusions may place patients at risk of ICU-acquired physical dependence on opioids.

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