Summary for Goal Section

 

Overall glucose goals for general hospital diabetes patients:  80-180 mg/dl

bulletWhile lower levels for diabetic patients have been written about, there is no current evidence to back this up.
bulletWhen glucoses are higher than this the following problems may occur:
bulletfluid and electrolyte loss
bulletWBC dysfunction - delayed phagocytosis
bulletgastroparesis

 

Glucose goal for post surgical ICU patients (not diabetes specific):  80-120 mg/dl

bulletThis is based on single New England Journal Paper with improved outcomes. 
bulletAdditional single site study on medical ICU patients showed similar improvement only for patients who were in the ICU for >3 days. 
bulletNew studies on IV insulin in MI patients have not shown benefit
bulletNew large scale studies on GIK (glucose-insulin-potassium) in cardiac patients have not shown benefit
bulletThere are now 3 large international multicenter studies to determine the true benefit of this ICU glucose control

 

Problems with High Glucoses:

bulletStudies have shown that high glucoses in hospitalized diabetes patients are associated with:
bulletincreased infection rate
bulletprolonged length of stay

Benefit of improving glucose level in the hospitalized Diabetic patient (prospective studies):

bulletStudies have shown that combinations intravenous insulin and other aggressive use of insulin in hospitalized diabetes patients to manage glucose levels are associated with:
bulletdecreased infection rate
bulletdecreased length of stay