Management of hyperglycemia in critical care

Abstract

Hyperglycemia is a common complication in critically ill patients. It is associated with an increased length of hospital stay, infection, and mortality rate. Hence, management of hyperglycemia in critical care settings is important. A literature search from inception till July 2019 using relevant keywords (hyperglycemia and critical illness) was performed with Medline (PubMed), and all the pertinent articles were selected to extract the literature describing the management of hyperglycemia in critically ill patients. Extensive evidence is available, which conclusively demonstrates that hyperglycemia is a marker of severity of illness in critically ill patients. Studies support the use of intensive insulin therapy in critically ill patients both with and without diabetes mellitus (DM). Glycemic variability and hypoglycemia contribute to the worsening condition. Hence, it is important to use the tools that monitor glycemic variability and hypoglycemia in critical care setting. In addition, consideration should be given for an insulin therapy, which lowers the glycemic variability and avoids hypoglycemia. While using insulins, nutrition plays an important role. Evidence supports the use of enteral nutrition over parenteral nutrition due to the low risk of infections and mortality. A transition from intravenous to subcutaneous (SC) insulin is required in certain patients for whom SC basal–bolus insulin therapy is preferred over a sliding-scale insulin regimen. Appropriate glycemic target and determining glycemic threshold for initiating insulin therapy are essential for the management of hyperglycemia in critically ill patients. Moreover, continuous blood glucose monitoring and appropriate medical nutrition therapy improve the patient outcomes.

Keywords

• critical illness
• hyperglycemia
• insulin