Guidelines for the Management of Hyperglycaemia and Hypoglycaemia in Critical Care

 

These guidelines are to be used to supplement the Trust “Hospital Inpatient Management of Diabetes” Guidelines 

and are designed to be used only on patients admitted to the Critical Care Unit.

 

       Key Principles

  • Hyperglycaemia in critically ill patients is very common and may be associated with a pre-existing diagnosis of Diabetes Mellitus (Type 1 or 2) or may represent a stress response to critical illness.
  • Avoidance of hyperglycaemia is desirable and the treatment threshold above which insulin should be commence is 10mmol/l with a target range of 7.8-10mmol/l. Treatment with exogenous insulin infusions is often required to treat hyperglycaemia. Insulin infusions are associated with hypoglycaemia and are a common cause of reported drug errors.
  • The avoidance of hypoglycaemia is of paramount importance as this has been associated with worse outcomes in critically ill patients.
  • Minimising glucose variability and increasing time in target range are important secondary targets.
  • It is likely that patients should have an individualised glucose target according to their history of diabetes, chronic glucose control and the nature of their presenting critical illness. However, until future randomised controlled trials are available, the best evidence supports using a liberal rather than intensive treatment strategy with a focus on avoiding hypoglycaemia and glycaemic variability
  • There is an increasing prevalence of type 2 diabetes in the population and with recent advances in novel antidiabetic agents that may have specific risks and benefits for the critically ill patient. This document aims to provide guidance on the use of these agents in the critical care unit.

 See pdf below for guidelines