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Hyperglycemia-Am I A
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Issues
 Hyperglycemia is associated with perioperative
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complications
Is there evidence to support intensive insulin
treatment in critically ill patients?
What is the ideal serum glucose for a critically ill
patient
A.B. completed training 2001
New associate completed training 2010
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Van den Berghe, G. et al.: N Engl J Med 2001;345:1359-67
 Intensive insulin therapy to maintain blood glucose
at or below 110 mg/dL reduces morbidity and
mortality among critically ill patients in the surgical
intensive care unit.
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Van den Berghe G et al.: N Engl J Med 2006;354:449-61
 No mortality difference between intensive insulin
therapy with strict control ( glucose 80-110mg/dL) vs.
conventional Rx (glucose < 180 mg/dL)
 Less mortality / morbidity in those treated in ICU for 3
or more days
 These patients could not be identified prior to therapy
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NICE - SUGAR
 Worldwide, multicenter (6104 pts, 42 hospitals)
 Expected to be in ICU > 3 days
 Intensive glucose control: 81-108 mg/L
 Conventional glucose control: < 180mg/dL
 Iv insulin given if glu > 180
 Mean glucose intensive control: 108
 Mean glucose conventional control: 144
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NICE - SUGAR
 Intensive glucose control increased 90 day mortality
 Intensive control mortality 27.5%
 Conventional control mortality 24.9%
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ACP Guideline: 2011
 DO NOT USE intensive insulin therapy to strictly
control glucose in non-SICU / MICU hospitalized
patients
 DO NOT USE intensive insulin therapy to
normalize serum glucose in SICU / MICU patients
 Target blood glucose in SICU / MICU patients 140200mg/dL
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Diabetes: Hospitalized patient
 Critically ill
 I.V. insulin for persistent hyperglycemia (180 mg/dl)
 Once insulin begun target glucose 140-180 mg/dl
 Not Critically ill
 Persistent blood glucose < 140 mg/dl if can be done
safely
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Consult Guys Replies
 Sign your junior associate
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