ABSTRACT: Stress-induced hyperglycemia has been associated with poor outcomes and death in critically ill patients. Blood glucose (BG) variability, a component of stress-related hyperglycemia has recently been reported as a significant independent predictor of intensive care unit and hospital mortality. We sought to evaluate three cases in which intensive insulin therapy was administered using a standardized insulin dosing protocol to normalize the BG and reduce glycemic variability. Point-of-care BG values and other clinical measures were obtained from the medical record of three patients who received intensive insulin therapy. This was a convenience sample of three patients where the BG level had stabilized on a consistent intravenous insulin dose rate for up to 20 hours in a surgical trauma intensive care unit. Data were collected manually and electronically using the Remote Automated Laboratory System-Tight Glycemic Control Module (RALS-TGCM®) BG management and monitoring system. Each case presentation describes a critically ill, nondiabetic patient, requiring continuous intravenous insulin therapy for hyperglycemia. In each instance, BG variability was present in a worsening patient condition after a period of normalization of hyperglycemia with intensive insulin therapy. Although decreasing BG variability is an important aspect of hyperglycemia management, new onset events of variability may be a sentinel warning or occur as a physiologic response to a worsening patient condition. If so, these events warrant rapid investigation and treatment of the underlying problem.
Randy D. Beadle, BSN RN CCRN, is a patient care coordinator in the surgical trauma/neurosurgical ICU at University Hospital, San Antonio, TX.
Susan D. Gerhardt, MSN RN, is the administrative director of the surgical trauma/neurosurgical ICU at University Hospital, San Antonio, TX.
Gail L. Kongable, MSN FNP, is the senior vice president, Analytic Services, The Episilon Group, Charlottesville, VA.
Ronald M. Stewart, MD, is professor and interim chair of the Department of Surgery, and the Jocelyn and Joe Straus Endowed Chair in Trauma Research at the University Health System and The University of Texas Health Science Center at San Antonio, TX.
Questions or comments about this article may be directed to Charles C. Reed, MSN RN CNRN, at firstname.lastname@example.org. He is a patient care coordinator in the surgical trauma/neurosurgical ICU at University Hospital, San Antonio, TX.
Sources of support: The authors claim no financial support for the development of this manuscript.