ABSTRACT
By
Marta Raurell Torredà, RN, MSN, Emilia Chirveches Pérez, RN, MSN, Maite Domingo
Aragón, RN, Rosa Martínez Ribe, RN, Emma Puigoriol Juvanteny, MStat, and Quintí
Foguet Boreu, MD, PhD
Background Intensive
insulin treatment is associated with an increased risk of hypoglycemia, so
strict glycemic monitoring is essential. The best type of sample for
identifying hypoglycemia remains under debate.
Objectives To establish
the number of hypoglycemic events in intensive care patients relative to
insulin administration method and the method used to collect the blood sample.
Methods Retrospective descriptive
study lasting 6 months. Hypoglycemia was defined as a blood glucose level less
than 80 mg/dL (mild: 50-79 mg/dL, severe: <50 mg/dL), measured with a
bedside glucometer and blood from the arterial catheter
or fingerstick, in critically ill patients who require insulin administered
subcutaneously (with sliding scales) or via continuous intravenous perfusion
(intense infusion protocol with a nurse-managed insulin therapy algorithm).
Results Analysis of the 6636
samples from 144 critically ill patients revealed 188 mildly hypoglycemic
samples (2.8%) and 3 severely hypoglycemic samples (0.04%). The prevalence of mild
hypoglycemia was greater when insulin was administered
intravenously (3.2%) rather than subcutaneously (2.3%; P = .04). Among patients receiving insulin
intravenously, hypoglycemia was found more often in arterial (4.5%) than in
capillary (2.8%) blood (P = .01). The prevalence of hypoglycemia in capillary blood samples
did not differ significantly between subcutaneous (2.3%) and intravenous (2.8%)
insulin therapies (P = .21).
Conclusions With a target
blood glucose level of 110 to 140 mg/dL, few hypoglycemic events are detected
in critically ill patients, regardless of whether insulin is administered
intravenously or subcutaneously. Analysis of solely arterial samples may yield
a higher prevalence of hypoglycemia than otherwise.
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