Intensive insulin therapy (IIT) is commonly used to control hyperglycemia in the intensive care unit (ICU) but may be complicated by hypoglycemia. Reversal of hypoglycemia with intravenous rescue dextrose (D50W) may contribute to further glucose variability, which is an independent risk factor for morbidity and mortality in critically ill patients. There is limited evidence establishing the dose response effect of rescue D50W on blood glucose (BG).
The dose-response effect of rescue D50W on BG depends on the dose, degree of hypoglycemia, and other patient-specific factors.
All adult subjects that were admitted to the burns surgery, cardiac, cardiothoracic surgery, neurosurgery, trauma surgery, and medical ICUs (8/2008 – 8/2009) and that were initiated a continuous insulin infusion were included. Data was collected from electronic records and included age, sex, history of diabetes mellitus (DM), hypoglycemic events (BG < 70 mg/dL), D50W dose, BG levels, and insulin infusion rate. Descriptive statistics and regression analysis were used.
There were 470 episodes ofhypoglycemia observed in 129 (28.4%) patients on IIT; 73 (56.6%) patientsexperienced recurrent events. The mean age was 57.4 ± 16.6 years, 68.2% weremale, and 50.4% had a history of diabetes. The overall mean andmedian? BG response were 4.69 ± 3.25 and 4.04 (2.53, 6.08) mg/dL pergram of rescue D50W administered. The median? BG were 4.5, 3.9, 4.1, and 3 mg/dL per gram of rescue D50W for 7.5-, 10-, 12.5-, and 25-g doses of D50W,respectively. Dose-adjusted? BG diminished with increasing rescue D50Wdose (regression coefficient -0.16, 95% CI -0.21, -0.11), severity ofhypoglycemia (regression coefficient -0.06, 95% CI -0.10, -0.03), and historyof DM (regression coefficient: -1.12, 95% CI -1.85, -0.38), p < 0.01.
The dose-response effect on BG is approximately 4 mg/dL per gram of rescue D50W administered in critically ill patients; it appears to be relatively consistent over a wide range of doses, degrees of hypoglycemia, and patient populations. A tailored approach to rescue dextrose administration for reversal of hypoglycemia may reduce glucose variability for patients on IIT.
University of California Davis Medical Center