Fast Five Quiz: Type 2 Diabetes in the Intensive Care Setting

Anne L. Peters, MD

Disclosures

January 25, 2022

Hyperglycemia (blood glucose concentration > 110 mg/dL) is common in the ICU and occurs in more than 80% of critically ill patients. Several factors affect blood glucose concentration in ICU patients, including insulin resistance. Some other noteworthy factors are severity of the acute illness, enteral or parenteral glucose administration, and use of steroids.

Hospitalization of patients with type 2 diabetes frequently leads to hyperglycemia or hypoglycemia because of the disruption of the outpatient balance of medications and diet. Both variability in blood glucose levels and hypoglycemia are associated with increased mortality. Thus, when patients with diabetes in the ICU are hyperglycemic, an intravenous insulin infusion is recommended. Although this can be demanding, it helps to minimize variability in blood glucose levels, which is common in critically ill patients. Alternatively, a long-acting subcutaneous insulin with additional short-acting insulin can be utilized.

According to the international Surviving Sepsis Campaign, all patients with severe sepsis who have blood glucose levels > 180 mg/dL should be started on intravenous insulin therapy. A typical target range after initiation of intravenous insulin therapy is 144-180 mg/dL.

Learn more about type 2 diabetes in critically ill patients.

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