blood glucose SS but no LAI

[baronzb]

In this context of several high BG readings with a pt., on SS but with no LAI, when is it a good time to recommend a LAI with the following contexts:

a. recent or current NPO or surgery

b. insulin naive pre-hospital

c. dextrose drips

Thank you. As you know, there are not many definitive answers, this appears to be a clinical judgement call.

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[TimeZero]

In this context of several high BG readings with a pt., on SS but with no LAI, when is it a good time to recommend a LAI with the following contexts:

a. recent or current NPO or surgery

b. insulin naive pre-hospital

c. dextrose drips

Thank you. As you know, there are not many definitive answers, this appears to be a clinical judgement call.

You answered your own question. It really depends on the patient and the setting. Hyperglycemia is associated with poor outcomes in the critical care setting. Goal BG is usually in the 140-180 range, targeting a lower range with IIT (insulin intensive therapy) really hasn't shown to be beneficial and carries an increase risk for hypoglycemia, obviously. Acutely critically ill patients usually are too unstable for subQ insulin, which would exclude them from receiving LAI. Once they stabilize they can be transitioned to subQ insulin, if they need it.

Hope this helps. There's plenty of literature out there that is readily available.

 

[baronzb]

You answered your own question. It really depends on the patient and the setting. Hyperglycemia is associated with poor outcomes in the critical care setting. Goal BG is usually in the 140-180 range, targeting a lower range with IIT (insulin intensive therapy) really hasn't shown to be beneficial and carries an increase risk for hypoglycemia, obviously. Acutely critically ill patients usually are too unstable for subQ insulin, which would exclude them from receiving LAI. Once they stabilize they can be transitioned to subQ insulin, if they need it.

Hope this helps. There's plenty of literature out there that is readily available.

Thank you. Can you elaborate on the points I mentioned in the OP? I'm still trying to digest this new responsibility.
What is a good source for further reading? Much obliged!

 

[TimeZero]

Thank you. Can you elaborate on the points I mentioned in the OP? I'm still trying to digest this new responsibility.
What is a good source for further reading? Much obliged!

I'm not going to address each point specifically, you need to formulate your own conclusions. I will say that a basal insulin may be appropriate if the patient's sugars are not controlled with SSI. Again, this depends on the patient's status and the setting.

I suggest you check to see if your institution has an internal protocol and/or order sets available.

Then check out UpToDate and see what the ADA/AACE and SCCM recommend.