• Deepashree Gupta, Meredith Kirn, Zafar A Jamkhana, Richard Lee, Stewart G Albert, and Kimberly M Rollins.
• Department of Internal Medicine, Division of Endocrinology, Saint Louis University School of Medicine, United States. Electronic address: dgupta4@slu.edu.
• Diabetes Metab Syndr. 2017 Oct 1; 11 (4): 265-271.

BackgroundTo assess the efficacy of a unified hyperglycemia and diabetic ketoacidosis (DKA) insulin infusion protocol (IIP), based on an Excel algorithm and implemented as an electronic order set, in achieving glycemic targets and minimizing hypoglycemia.MethodsAn IIP was instituted in medical and surgical intensive care units for post-cardiac surgery (PCS) and other stress hyperglycemia (SH), diabetes hyperglycemia (DH), and DKA. The IIP initiated therapeutic insulin rates at elevated blood glucose (BG), and decreased insulin when target range was achieved. A convenience sample (n=62) was studied; 20 PCS, 15 with DH, 9 with SH, 8 with diabetes on vasopressors, 7 with diabetes on glucocorticoids and 3 with DKA were assessed.ResultsThe protocol maintained BG at 144±24.7mg/dL for PCS and 167±36mg/dL for patients with diabetes mellitus. It maintained acceptable target range (ATR) (100mg/dL-180mg/dL) 89% of the time for PCS and 67% of the time for patients with diabetes mellitus. There were no measurements of BG<70mg/dL. The protocol lowered the BG at a similar rate and time period in those with diabetes, DKA and those with or without vasopressors or glucocorticoids. To determine long-term efficacy, a retrospective review of Point of Care (POC) RALS (Remote Automated Data System) BG data 2 years post implementation demonstrated fewer episodes of hypoglycemia<70mg/dL and hyperglycemia>240mg/dL and more BG values within ATR.ConclusionsThis IIP maintained ATR without hypoglycemia for patients in the ICU setting without requiring complex nursing calculations.Copyright © 2016 Diabetes India. Published by Elsevier Ltd. All rights reserved.

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