Nurse-Directed Blood Glucose Management in a Medical Intensive Care Unit

BACKGROUND Insulin-delivery algorithms for achieving glycemic control in the intensive care unit require frequent checks of blood glucose level and thus increase nursing workload. Hypoglycemia is a serious complication associated with intensive insulin therapy. OBJECTIVES To evaluate a nurse-directed protocol for blood glucose management that allows individualized insulin delivery within a predefined blood glucose corridor, intended to avoid hypoglycemia while maintaining adequate control of blood glucose level without increasing nursing workload. METHODS A nurse-directed protocol for blood glucose management was developed by an interprofessional team, and the protocol’s performance was investigated in 175 patients compared with 384 historical controls. RESULTS With the nurse-directed protocol, hypoglycemia incidents declined significantly (31% vs 12%, P < .001), and minimum blood glucose levels increased significantly (80 mg/dL vs 93 mg/dL, P < .001). Mean and maximum blood glucose levels, the proportion of glucose readings within the target range (31% vs 26%, P = .06), and the number of blood glucose checks (59 vs 58, P = .85) remained unchanged with use of the protocol. CONCLUSION Implementation of the nurse-directed protocol for blood glucose management did not increase nursing workload but reduced hypoglycemia incidents significantly while maintaining adequate glycemic control.

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The Effect Of Controlling Hyperglycemia On The Morbidity And Mortality Of Intensive Care Unit (ICU) Patients

European Scientific Journal ESJ ◽

10.19044/esj.2016.v12n18p184 ◽

2016 ◽

Vol 12 (18) ◽

pp. 184

Author(s):

Hiyam Al-Haqeesh ◽

Abla Al-Bsoul ◽

Hussein Shalan ◽

Aysha Abedalhameed Al-khalaylah ◽

Nares Musa Ahmad Hakouz ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Blood Glucose ◽

Blood Glucose Level ◽

Glucose Level ◽

Intervention Group ◽

Target Range ◽

Control Group ◽

Management Protocol ◽

Glucose Management

Introduction: Hyperglycemia and insulin resistance are common in critically ill patients, even if they have not previously had diabetes, and the risk of mortality or significant morbidity is high among those who are treated in the intensive care unit (ICU) for more than 5 days. Objective: To assess the effect of glucose management protocol on mortality and morbidity in a heterogeneous population of critically ill adult patients. Design: A randomized controlled trial. Setting: A 24-bed medical-surgical intensive care unit (ICU) for adult patients at King Hussein Medical Center, the Royal Medical Services. Methods: A total of 50 patients who were considered to need intensive care for at least three days, were randomly assigned into two groups. The intervention group subjects were to undergo a glucose control protocol with insulin infusion titrated to maintain blood glucose level in a target range of 120-160 mg/dL; except septic patients, in whom the target was higher, 160- 180 mg/dL. Patients in the second group (control group) were treated by a conventional approach with reduction of blood glucose level only if the level was markedly elevated (>200 mg/dL) to maintain blood glucose level in a target range of 180-200 mg/dL. Results: After adjustment for baseline characteristics the 2 groups of patients were well matched, for age, sex, prevalence of diabetes mellitus, HbA1c value and distribution of diagnoses; the only significant difference was in the percentage of cardiovascular dysfunction, which was higher in the intervention group (p=0.047). After institution of the protocol, the mean blood glucose levels differed significantly between the two treatment groups during the study period (143.70±12.78 mg/dL in the intervention group versus 175.56±14.07 mg/dL in the control group (p<0.001). And patients in the intervention group received a larger mean insulin dose 28.32 ±16.38 units per day, vs. 14.60±12.26 in the control group (p=0.001). The difference in mortality between the two treatment groups was not significant at 28 days (p=0.370) and at 60 days (p=0.555). No significant increase in hypoglycemia episodes was reported in our blood glucose level target. Conclusion: The glucose management protocol resulted in significantly improved glycemic control and was not associated with increased rate of death or hypoglycemia.

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Implementation Of Intervention Program For Controlling Glucose Level Among ICU Patients

European Scientific Journal ESJ ◽

10.19044/esj.2016.v12n18p1 ◽

2016 ◽

Vol 12 (18) ◽

pp. 1

Author(s):

Hiyam Al-Haqeesh ◽

Shereen Ziad Alhuneity ◽

Laith A Obeidat ◽

Ali Sayel Al Rashaydah ◽

Jebril Ahmed Albedoor ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Blood Glucose ◽

Blood Glucose Level ◽

Glucose Level ◽

Intervention Group ◽

Target Range ◽

Control Group ◽

Management Protocol ◽

Glucose Management

Introduction: Hyperglycemia and insulin resistance are common in critically ill patients, even if they have not previously had diabetes, and the risk of mortality or significant morbidity is high among those who are treated in the intensive care unit (ICU) for more than 5 days. Study objectives: To assess the effect of glucose management protocol on mortality and morbidity in a heterogeneous population of critically ill adult patients. Methods and materials: Study design: A randomized controlled trial. Study setting: Intensive care unit (ICU) for adult patients at King Hussein Medical Center, the Royal Medical Services. Study sample: A total of 50 patients were included in this study and assigned randomly into two groups, control group (N=25), and intervention group (N=25). Study protocol: The intervention group subjects were to undergo a glucose control protocol with insulin infusion titrated to maintain blood glucose level in a target range of 120-160 mg/dL; except septic patients, in whom the target was higher, 160- 180 mg/dL. Patients in the second group (control group) were treated by a conventional approach with reduction of blood glucose level only if the level was markedly elevated (>200 mg/dL) to maintain blood glucose level in a target range of 180-200 mg/dL Study findings: Although the difference in mortality between the two treatment groups was not significant at 28 days (p=0.370) and at 60 days (p=0.555), but it was to be considered for further improvements. No significant increase in hypoglycemia episodes was reported in our blood glucose level target. There was no significant difference in the development of new organ failure, new renal insufficiency, number of patients undergoing transfusion of packed red blood cells, use of antibiotics for more than 10 days, length of stay in the ICU and length of stay in the hospital. It was noticed that the rates of positive blood cultures were lower in the interventional group (8%) than in the control group (32), (p=0.068). Conclusion: The glucose management protocol resulted in significantly improved glycemic control and was not associated with increased rate of death or hypoglycemia.

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Association between blood glucose levels and Glasgow Outcome Score in patients with traumatic brain injury: secondary analysis of a randomized trial

Trials ◽

10.1186/s13063-022-06005-5 ◽

2022 ◽

Vol 23 (1) ◽

Author(s):

Tao Yuan ◽

Hongyu He ◽

Yuepeng Liu ◽

Jianwei Wang ◽

Xin Kang ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Blood Glucose ◽

Brain Injury ◽

Blood Glucose Level ◽

Glucose Level ◽

Threshold Effect ◽

Glasgow Outcome Score ◽

Glucose Levels ◽

Blood Glucose Levels ◽

Average Blood Glucose

Abstract Background Blood glucose levels that are too high or too low after traumatic brain injury (TBI) negatively affect patient prognosis. This study aimed to demonstrate the relationship between blood glucose levels and the Glasgow Outcome Score (GOS) in TBI patients. Methods This study was based on a randomized, dual-center, open-label clinical trial. A total of 208 patients who participated in the randomized controlled trial were followed up for 5 years. Information on the disease, laboratory examination, insulin therapy, and surgery for patients with TBI was collected as candidate variables according to clinical importance. Additionally, data on 5-year and 6-month GOS were collected as primary and secondary outcomes, respectively. For multivariate analysis, a generalized additive model (GAM) was used to investigate relationships between blood glucose levels and GOS. The results are presented as odds ratios (ORs) with 95% confidence intervals (95% CIs). We further applied a two- piecewise linear regression model to examine the threshold effect of blood glucose level and GOS. Results A total of 182 patients were included in the final analysis. Multivariate GAM analysis revealed that a bell-shaped relationship existed between average blood glucose level and 5-year GOS score or 6-month GOS score. The inflection points of the average blood glucose level were 8.81 (95% CI: 7.43–9.48) mmol/L considering 5-year GOS as the outcome and were 8.88 (95% CI 7.43−9.74) mmol/L considering 6-month GOS score as the outcome. The same analysis revealed that there was also a bell relationship between average blood glucose levels and the favorable outcome group (GOS score ≥ 4) at 5 years or 6 months. Conclusion In a population of patients with traumatic brain injury, blood glucose levels were associated with the GOS. There was also a threshold effect between blood glucose levels and the GOS. A blood glucose level that is either too high or too low conveys a poor prognosis. Trial registration ClinicalTrials.gov NCT02161055. Registered on 11 June 2014.

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EFFECTIVENESS OF AMLA JUICE IN REDUCING BLOOD GLUCOSE LEVEL AMONG PATIENTS WITH TYPE II DIABETES IN A SELECTED AREA OF KANYAKUMARI DISTRICT

THE RESEARCH RESERVOIR ◽

10.47211/trr.2021.v07i01.012 ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Mrs. Vanitha. S s ◽

Dr. Pramjit kaur

Keyword(s):

Blood Glucose ◽

Standard Deviation ◽

Blood Glucose Level ◽

Glucose Level ◽

Type Ii Diabetes ◽

Control Group ◽

Type Ii ◽

Glucose Levels ◽

Blood Glucose Levels ◽

Experimental Group

Challenges in lifestyle, such as increasesin energy intake and decreasesin physical activity are causing overweight and obesity leading to epidemic increases in type II Diabetes Mellitus. The research approach used for this study was evaluative approach and the research design was true experimental design. 60 patients with type II diabetes, 30 in experimental group and 30 in control group were selected for this study by using purposive sampling technique. Data was collected with the help of self-structured interview schedule. Descriptive statistics (frequency, percentage, mean and standard deviation) and inferential statistics (chi-square, paired ‘t’ test) were used to analyse the data and to test the hypotheses. In the experimental group,the pre-test mean score was 2.966, mean percentage was 59% and standard deviation was 1.129 and in post-testmean score was 2.533, mean percentage was 50.66% and standard deviation was 1.074 with effectiveness of 8.34% and paired‘t’ test value of t=3.971,which was statistically significant (p<0.05) which is an evidence ofthe effectiveness of Amla juice in reducing blood glucose level. Comparison of blood glucose levels in experimental and control groups, shows that the value is statistically highly significant, as was observed from the unpaired ‘t’ test value of 13.39 with P value of <0.05, which is an evidence indicatingthe effect of Amla juice in reducing postprandial blood glucose levels. The resultsfound that the administration of Amla juice did have aneffect in reducing blood glucose level in the experimental group. By comparing the findings of pre-test and post test between the experimental group and the control group,the effect was identified (assessed). The study concluded that the Amlajuice is effective in reducing blood glucose level.

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Comparison of Functional Regression and Functional Principal Component Regression for Estimating Non-Invasive Blood Glucose Level

Indonesian Journal of Statistics and Its Applications ◽

10.29244/ijsa.v5i1p14-25 ◽

2021 ◽

Vol 5 (1) ◽

pp. 14-25

Author(s):

Nurul Fadhilah ◽

Erfiani Erfiani ◽

Indahwati Indahwati

Keyword(s):

Blood Glucose ◽

Blood Glucose Level ◽

Glucose Level ◽

Principal Component Regression ◽

Principal Component ◽

Functional Regression ◽

Glucose Levels ◽

Non Invasive ◽

Blood Glucose Levels ◽

Functional Principal Component

The calibration method is an alternative method that can be used to analyze the relationship between invasive and non-invasive blood glucose levels. Calibration modeling generally has a large dimension and contains multicolinearities because usually in functional data the number of independent variables (p) is greater than the number of observations (p>n). Both problems can be overcome using Functional Regression (FR) and Functional Principal Component Regression (FPCR). FPCR is based on Principal Component Analysis (PCA). In FPCR, the data is transformed using a polynomial basis before data reduction. This research tried to model the equations of spectral calibration of voltage value excreted by non-invasive blood glucose level monitoring devices to predict blood glucose using FR and FPCR. This study aimed to determine the best calibration model for measuring non-invasive blood glucose levels with the FR and FPCR. The results of this research showed that the FR model had a bigger coefficient determination (R2) value and lower Root Mean Square Error (RMSE) and Root Mean Square Error Prediction (RMSEP) value than the FPCR model, which was 12.9%, 5.417, and 5.727 respectively. Overall, the calibration modeling with the FR model is the best model for estimate blood glucose level compared to the FPCR model.

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Comparison of capillary and venous blood glucose levels using glucometer and laboratory blood glucose level in poisoned patients being in coma

Advanced Biomedical Research ◽

10.4103/2277-9175.170242 ◽

2015 ◽

Vol 4 (1) ◽

pp. 247 ◽

Cited By ~ 4

Author(s):

LeilaKamali Dolatabadi ◽

Ahmad Yaraghi ◽

NastaranEizadi Mood

Keyword(s):

Blood Glucose ◽

Blood Glucose Level ◽

Glucose Level ◽

Venous Blood ◽

Glucose Levels ◽

Blood Glucose Levels

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EFFECT OF AEROBIC EXERCISES AND RESISTANCE TRAINING ON GLUCOSE LEVELS IN TYPE 2 DIABETIC SUBJECTS.

Asian Journal of Pharmaceutical and Clinical Research ◽

10.22159/ajpcr.2017.v10i7.18532 ◽

2017 ◽

Vol 10 (7) ◽

pp. 360

Author(s):

Aishwarya Pramod Benkar ◽

Smita Bhimrao Kanase

Keyword(s):

Diabetes Mellitus ◽

Blood Glucose ◽

Resistance Training ◽

Blood Glucose Level ◽

Glucose Level ◽

Postprandial Blood Glucose ◽

Glucose Levels ◽

Blood Glucose Levels ◽

Significant Difference

Objective: Diabetes mellitus is a leading cause of death and disability in the world and its prevalence is predicted to rise to 10% by 2030. Hence, this study is conducted with objectives to find out the effect of aerobic exercises and resisted exercises on blood glucose levels in type 2 diabetes mellitus (T2DM) subjects and to compare the effect of both exercises on blood glucose level.Method: The comparative study was conducted at Krishna Institute of Medical Sciences Deemed University, Physiotherapy department, Karad. 30 participants with age group between 30 and 65 years were taken. Subjects were selected as per inclusion and exclusion criteria. Group A (15) participants were given aerobic exercise on static bicycle, and Group B (15) participants were given resistance training using dumbbells and weight cuffs for 5 days/week for 4 weeks. Diet recommendations were given to every participant.Results: Statistical analysis was performed using paired and unpaired t-test. Analysis showed statistically extremely significant difference in fasting blood glucose level and postprandial blood glucose level in both the groups (p≤0.0001).Conclusion: Thus, this study concludes that both aerobic exercises and resistance training prove to be beneficial in controlling blood glucose levels in T2DM subjects.

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Associations between dynamics of the blood glucose level after hypoglycemia and intensive care unit mortality: a retrospective multicenter study

Intensive Care Medicine ◽

10.1007/s00134-015-3956-1 ◽

2015 ◽

Vol 41 (10) ◽

pp. 1864-1865

Author(s):

Roosmarijn T. M. van Hooijdonk ◽

Jan M. Binnekade ◽

Ameen Abu–Hanna ◽

Floris van Braam Houckgeest ◽

Lieuwe S. Hofstra ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Blood Glucose ◽

Blood Glucose Level ◽

Glucose Level ◽

Multicenter Study ◽

Intensive Care Unit Mortality ◽

Retrospective Multicenter Study

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BLOOD GLUCOSE LEVEL IN MICE.

Acta Endocrinologica ◽

10.1530/acta.0.0520357 ◽

1966 ◽

Vol 52 (3) ◽

pp. 357-367 ◽

Cited By ~ 63

Author(s):

Claus Rerup ◽

Ingmar Lundquist

Keyword(s):

Blood Glucose ◽

Blood Glucose Level ◽

Blood Sugar ◽

Glucose Level ◽

Enzymatic Reaction ◽

Sampling Procedure ◽

Experimental Conditions ◽

Glucose Levels ◽

Blood Glucose Levels ◽

Blood Sugar Response

ABSTRACT Multiple serial blood glucose level determinations in individual mice were performed on small blood samples (10–25 μl) using the orbital bleeding technique. Glucose was determined specifically by a known enzymatic reaction. Blood glucose determined in this way was found a parameter of high reproducibility and precision, the latter being shown by the finding that differences between individual animals were highly significant in practically all the experiments. The standard deviation of the single measurement in normal mice was ± 8.2 mg/100 ml as determined from 600 samples, which indicated that the technique allows of the detection of blood sugar level changes of about 15 mg/100 ml or more with very high significance, in a group of 5 mice. In the sampling procedure as such, intravenous or subcutaneous saline injections did not necessarily have any effect on the blood glucose level, but interpretation of slight blood sugar changes under experimental conditions should always be based on a comparison with control groups, since the latter may sometimes show a slight but significant change. In normal non-fasting mice (NMRI strain) significant differences in homoeostatic blood glucose level adjustments were demonstrated. In acutely adrenalectomized mice blood glucose levels were lower and more variable than in normals. Alloxan injection (70 mg/kg) was followed in individual mice by a triphasic blood sugar response, as is known from other species.

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