Managing Hypoglycemia & Hyperglycemia Critical Care Adult Patients

RISK FACTORS Diabetes Medication Adverse Effects HYPOGLYCEMIA HYPERGLYCEMIA Diabetes Medication Adverse Effects Medication Interactions Continuous Renal Replacement Therapy Sepsis Nutrition Imbalance Diabetes Medication Adverse Effects Medication Interactions Sepsis Stress Induced Nutrition Imbalance RISK FACTORS

Effective glucose control in the intensive care unit (ICU) has been shown to decrease morbidity across a large range of conditions and also to decrease mortality (IHI,2009). 

TIGHT GLYCEMIC CONTROL IN CRITCALLY ILL ADULTS Target range is 80-110 Hyperglycemic patients are started on a Regular Insulin drip titrated depending on blood glucose levels. Blood glucose levels are check every hour Each institution has a protocol with guidelines for titration

Managing Hypoglycemia Blood glucose less than 70 or per hospital policy/protocol First assess the patient to see if they exhibit symptoms ex: change in mental status, irritability. Medication usually given are: 1. Orange juice orally followed by a snack 2. Glucagon IM or IV 3. Dextrose 50% IV (most common in ICU)

Managing Hyperglycemia PRN sliding scale with fast acting Regular or Aspart insulin is used mostly for Diabetics Ex. If blood glucose 200-249 Give 2 units Regular insulin SQ Longer acting insulin (NPH, Levemir, Lantus) is usually administered daily For tight glycemic control or critically abnormal high (>400) glucose levels, continuous Regular insulin IV is given

REVIEW Hypoglycemia is a priority issue and is mostly managed with D50 IV Hyperglycemia is equally important and is managed with insulin. Only regular insulin is administered IV It’s important to monitor blood glucose levels as well as assess the patient.