damn metrics...insulin drips for hyperglcemia

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Hamhock

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Is anyone using insulin drips to control moderate hyperglycemia in medical patients?

How about severe hyperglycemia? (defined as you wish)

We were just presented with a new metric to keep glucose <180 on 90% of fingersticks...and admin strongly suggests insulin drips.

Does anyone -- after reading the extensive literature on this topic -- actually have a targeted range?

Anyone forced to consider such a metric?

HH

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Suits don't care about the literature.

We also have targets of glucose less than 180 90% of the time. Usually get there too but don't use drips. The APPs are just aggressive with the sub q sliding scales and long acting insulin.
 
Is anyone using insulin drips to control moderate hyperglycemia in medical patients?

How about severe hyperglycemia? (defined as you wish)

We were just presented with a new metric to keep glucose <180 on 90% of fingersticks...and admin strongly suggests insulin drips.

Does anyone -- after reading the extensive literature on this topic -- actually have a targeted range?

Anyone forced to consider such a metric?

HH

This approach got us in trouble before.
 
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Please tell me more of what you are referring to...

Thanks, Hamhock

Strict glycemic control lead to bad outcomes in the past
 
Are we calling <180 strict here?

Well, not really. But if your hospital is pushing these drips inevitably you will run into hypoglycemic complications. Isn't this what happened in the late 90s, early 2000s?
 
We were just presented with a new metric to keep glucose <180 on 90% of fingersticks
try ordering Q1H fingersticks on every single patient that doesn't have glycemic issues. you'll hit your 90% benchmark, amiright?!
 
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Well, not really. But if your hospital is pushing these drips inevitably you will run into hypoglycemic complications. Isn't this what happened in the late 90s, early 2000s?

Ultimately the numbers matter regardless of similar theme. Of course any glucose control is going to come at the cost of increased hypoglycemia, just a matter of finding the right balance. If there's enough of an evidence base to establish >90% at <180 as a quality metric isn't something I can weigh in on better than others here, and whether the establishment of the metric itself is an effective means of improving outcome is another discussion
 
Ultimately the numbers matter regardless of similar theme. Of course any glucose control is going to come at the cost of increased hypoglycemia, just a matter of finding the right balance. If there's enough of an evidence base to establish >90% at <180 as a quality metric isn't something I can weigh in on better than others here, and whether the establishment of the metric itself is an effective means of improving outcome is another discussion

Agree. I don't want my patients to be hyperglycemic but I don't want to start a drip for a glucose of 210 on day one without any evidence that doing so affects outcome.

And like you, I'm not aware of any evidence that suggests that this is what we should be doing. Perhaps there is and I am just unaware.
 
Agree. I don't want my patients to be hyperglycemic but I don't want to start a drip for a glucose of 210 on day one without any evidence that doing so affects outcome.

And like you, I'm not aware of any evidence that suggests that this is what we should be doing. Perhaps there is and I am just unaware.

LA7dlGZh.jpg

A little dated, not sure if anything new's been done
 
Our institution follows the guidelines of 140-180; a better question is: How many finger sticks or DAYS are you willing to try sliding scale until you pull the trigger on a drip? A number of patients in the ICU are diabetic or pre-diabetic; and there are a host of factors and meds that can wreak havoc on blood sugar in the ICU (stress of critical illness; steroids; npo; tube feeds). Not sure that sliding scale +/- long acting will give you control in the 140-180 range any time soon with a bunch of changing factors, so I go to a drip with 2-3 readings above range in the face of ssi. And "no" there is no rct to support this approach for all of you who are chomping at the bit to point that out...
 
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