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