Efficacy and safety of a new insulin infusion protocol adapted for the target glycemic range of 140–180 mg/dl in adult critical care units: a tertiary care centre experience

Introduction: In critical care setting, insulin infusion rather than subcutaneous insulin is recommended to maintain the blood glucose (BG) level in the target range. We have devised an insulin infusion protocol which requires monitoring of blood glucose and insulin dose adjustment one hourly. In this study, we have studied the efficacy of our insulin infusion protocol (IIP) in terms of bringing and maintaining blood glucose to target range, and its safety in terms of preventing hypoglycemia. Research design and methods: It is a retrospective review of all patients who received insulin infusion from the 1st of July 2017 to the 30th of June 2018. A total of 231 were included and data pertaining to demographic details and related to insulin infusion was documented in a predefined questionnaire. Results: Insulin infusion was continued for a mean duration of 26.3 ± 13.7 h taking 5.7 ± 3.1 h to reach the target BG level < 180 mg/dl. Once the BG was in the target range, 44.3% of blood glucose readings were between 140 and 180 mg/dl, 62.52% of readings were within the safe range, i.e. 110–180 mg/dl while hypoglycemia (< 70 mg/dl) was observed in only 0.44% times with only one episode of severe hypoglycemia (< 40 mg/dl). The 31.65% of BG readings were found to be above the target BG level (> 180 mg/dl) but the mean BG remains 168.95 ± 45.52 within the desired target range. Conclusion: Our insulin infusion protocol not only achieved and maintained the blood glucose in the target range, it is safe with a very low risk of hypoglycemia.