Comparisons of different insulin infusion protocols: a review of recent literature

Curr Opin Clin Nutr Metab Care. 2010 Mar;13(2):198-204. doi: 10.1097/MCO.0b013e32833571db.

Abstract

Purpose of review: To provide an update on the currently available insulin infusion protocols for treatment of hyperglycemia in critically ill patients and to discuss the major differences and similarities among them.

Recent findings: We identified a total of 26 protocols, 20 of which used manual blood-glucose calculations, and six that used computerized algorithms. The major differences and similarities among the insulin infusion protocols were in the following areas: patient characteristics, target glucose level, time to achieve target glucose level, incidence of hypoglycemia, rationale for adjusting the rates of insulin infusion, and methods of blood-glucose measurements. Several computerized protocols hold promise for safer achievement of glycemic targets.

Summary: Insulin infusion is the most effective method for controlling hyperglycemia in critically ill patients. Clinicians should utilize a validated insulin infusion protocol that is well tolerated, and is most appropriate and practical for their institution based on the resources that are available.

Publication types

  • Review

MeSH terms

  • Algorithms
  • Blood Glucose / metabolism
  • Clinical Protocols
  • Critical Care / methods*
  • Critical Illness
  • Humans
  • Hyperglycemia / drug therapy*
  • Hypoglycemic Agents / administration & dosage*
  • Infusions, Intravenous
  • Insulin / administration & dosage*

Substances

  • Blood Glucose
  • Hypoglycemic Agents
  • Insulin