1. Managing Hypoglycemia & Hyperglycemia
Critical Care Adult Patients

2. 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

3. 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). 

4. TIGHT GLYCEMIC CONTROL IN CRITCALLY ILL ADULTS
Target range is
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

5. 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)

6. Managing Hyperglycemia
PRN sliding scale with fast acting Regular or Aspart insulin is used mostly for Diabetics Ex. If blood glucose 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

7. 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.