Visits: 13
Recently the American Association of Clinical Endocrinologists (AACE) and the American Diabetes Association (ADA) jointly have issued clinical recommendations on the proper treatment of hospitalized patients with high blood glucose levels.
For critically ill patients:
• For treatment of persistent hyperglycemia, beginning at a threshold of no greater than 180 mg/dL (10.0 mmol/L), insulin therapy should be started.
• For most critically ill patients, glucose level between 140 to 180 mg/dL (7.8 – 10.0 mmol/L) is recommended once insulin therapy has been started.
• Continuous intravenous insulin infusions are preferred to achieve and maintain the glycaemic control in critically ill patients.
• Validated insulin infusion protocols that are shown to be safe and effective and to have low rates of hypoglycemia are recommended.
• Frequent glucose monitoring is essential for the patients receiving intravenous insulin to reduce hypoglycemia and to achieve optimal glucose control.
For non-critically ill patients:
• For most non-critically ill patients receiving insulin therapy, targets if can be safely achieved should be-
FBS (Fasting blood glucose) level < 140 mg/dL (< 7.8 mmol/L), and
RBS (Random blood glucose) level < 180 mg/dL (< 10.0 mmol/L).
• More rigorous targets may be appropriate in stable patients in whom tight glycaemic control was previously achieved.
• Less stringent targets may be appropriate in terminally ill patients or in those with severe co-morbidities.
• For achieving and maintaining glycaemic control, the preferred method is scheduled subcutaneous administration of insulin, with basal, nutritional, and correction components.
• As the only therapeutic agent, prolonged treatment with sliding-scale insulin is discouraged.
• For most hospitalized patients who require the treatment of hyperglycemia, non-insulin anti-hyperglycemic agents are not appropriate.
• Day-to-day decisions concerning treatment of hyperglycemia must be based on clinical judgment and ongoing evaluation of clinical status.