Authors: Rattan Juneja¹*, Adam Golas¹, Joni Carroll¹, Deborah Nelson¹, Samuel Flanders¹ and Corbin Roudebush¹. ¹Indiana University and Clarian Health Partners, Indianapolis, IN, United States, 46202.

Aim: Acute hyperglycemia, both recognized and unrecognized, is fairly common in the hospital and not only is it associated with increased morbidity and mortality but efforts to achieve Tight Glucose Control (TGC) with subcutaneous insulin present challenges. We have previously reported that TGC can be achieved safely and effectively in ICUs utilizing an indigenously developed computerized IV Insulin (IVI) program that uses insulin sensitivity factors/multiplier (1). Numerous safeguards are built in and a paper record is maintained in case of computer malfunction. In this open label study, we evaluated the feasibility and safety of our IVI protocol in 251 patients (353 drip runs) admitted to Medical/Surgical Units at an academic Medical Center (University Hospital) and a semi-private Hospital (Methodist Hospital). Target Blood Glucose (BG) was set at 100-150 mg/dl for these insulin infusions.

Results: Initial BG was in the target range (100-150mg/dl) in 82/353 (23.2%) drip runs and remained at target throughout the infusion period. Of the 271 drips that were not at target on the initial BG, 268 (98.9%) achieved and maintained the BG target. The overall rate of hypoglycemia (< 50 mg/dl) was only 0.52%.

Conclusions: Our computerized IVI offers a safe and effective alternative to sliding scale or no insulin therapy in achieving and maintaining TGC on Medical/Surgical non-intensive care Units. The cost effectiveness of this approach however still needs to be determined.

References: (1) Juneja, Rattan; Macy, Angela; Wall, Donna; Wolverton, Cheryl; Roudebush, Corbin; Flanders, Samuel J; Utilization Of A Computerized IV Insulin Infusion Protocol To Control Blood Glucose In The ICU; Diabetes, 54 (Suppl 1), June 2005, A103