Introduction:
Managing blood glucose levels at the normal level is called glycemic control. In the case of critically ill patients, glycemic control aims to maintain the glucose level within a range that minimizes the risk of hyperglycemia (increased blood sugar level) and hypoglycemia (reduced blood glucose level). Hyperglycemia is commonly seen in critically ill patients and is related to an increased chance of mortality and morbidity. Hypoglycemia is also seen in critically ill patients, leading to neurological impairment and sometimes death. Therefore maintaining glycemic control is essential in the case of critically ill patients.
Insulin therapy is the most commonly used method in critical care patients. It requires close monitoring of the glucose level. The blood glucose level is maintained within a range of 140 to 180 mg/dL in critically ill patients.
What Is the Importance of Controlling Glycemic Levels in Critical Care Patients?
Controlling the glucose level is very important in critical care patients because of the following reasons:
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Improved Clinical Outcome - Maintaining the glucose level at the optimal range helps improve clinical outcomes and decrease the mortality rates and infections, and there will be shorter hospital stays.
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Reduced Risks and Complications - Both hyperglycemia and hypoglycemia can result in different risks and complications. Hyperglycemia can result in an increased chance of infection, reduced wound healing and immune functions. Hypoglycemia results in neurological impairment and sometimes even death.
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Better Management of Underlying Medical Conditions - Most of the critically ill patients will have underlying medical conditions like diabetes that require careful management of glucose control to prevent complications. In such cases, controlling glycemic levels can be challenging due to the critical illness and the underlying medical conditions. Close monitoring is needed to achieve optimal glucose control in such patients.
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High Insulin Resistance - Patients with a critical illness can have high insulin resistance, making it difficult to maintain normal glycemic levels. Insulin therapy will help overcome insulin resistance and maintain optimal or normal glycemic levels.
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Decreased Healthcare Cost - By maintaining and controlling the normal glycemic level, the healthcare cost and hospital stays can be reduced.
What Is the Target Range of Glucose in Critically Ill Patients?
Critically ill patients have no universally accepted targeted or optimal glucose range. Most studies suggest that the optimal glucose level range should be between 140 to 180 mg/dL, which is associated with higher clinical outcomes and reduced complications.
According to the American diabetes association, the glycemic level should be 140 to 180 mg/dL in critically ill patients. It should have a lower target range of 110 to 140 mg/dL for selected people, like patients with cardiac surgery or stroke history. According to the Society of critical care medicine, the recommended level of glycemic range is 140 to 180 mg/dL, with a lower range of 110 to 140 mg/dL.
However, maintaining the optimal level of glucose control in critical care patients can be challenging because they have various degrees of resistance to insulin and metabolic stress. So close monitoring of the blood sugar level is needed. Individualized insulin therapy and adjusting insulin dosage are essential to maintain the optimal control of glycemic levels.
Which Are the Different Methods for Achieving Glycemic Control in Critically Ill Patients?
Glycemic control in critically ill patients can be achieved by various methods like the use of insulin infusion, individualized insulin dosing, nutritional management, by using glucose-lowering medications, education, training, etc. The different methods for achieving glycemic control in critically ill patients include the following:
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Insulin Therapy - Insulin therapy is the primary treatment option for maintaining glycemic control in critical care patients. It can be administered by various routes, like subcutaneous, intravenous, or inhaled. The most commonly used method of administration of insulin in the case of critically ill patients is intravenous infusion. With the intravenous infusion, there will be precise control of the glycemic level, and it can be adjusted based on the patient's response to therapy. It can be customized depending on the patient's need, insulin resistance, and therapy response. Insulin therapy usually starts when the glucose level is over 180 mg/dL. The insulin therapy targets keeping the blood glucose level within an optimal level of 140 to 180 mg/dL in critical care patients.
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Enteral Nutrition - Enteral nutrition is used to provide nutritional support to critical care patients who cannot normally eat because of any illness or surgical procedures. The enteral route is the administration of nutrition by feeding which is placed in the small intestine or stomach. It has many advantages over the intravenous catheter or parenteral nutrition, like decreased infection, and it improves the function of the gut. Enteral nutrition helps maintain an optimal level of glucose in the blood, which helps achieve glycemic control in critical care patients.
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Continuous Glucose Monitoring - With this technology, the blood glucose level is monitored carefully in critically ill patients. The continuous glucose monitoring system has a small sensor inserted below the skin, displaying the real-time glucose level. With the help of this monitoring device, the insulin dosage can be adjusted accordingly. It also helps detect hyperglycemia and hypoglycemia better than the traditional methods of monitoring glucose levels. The advantages of continuous glucose monitoring over the traditional monitoring method include improved monitoring frequency, giving real-time glucose levels, and detection of hypoglycemia and hyperglycemia. Continuous glucose monitoring can also be used in critical care patients to determine the glucose level in patients receiving enteral or parenteral nutrition.
Conclusion:
In conclusion, glycemic control is essential in managing critically ill patients. Both hypoglycemia and hyperglycemia are associated with a high risk of mortality and morbidity. So controlling the glycemic level is essential. There are different methods for maintaining the glycemic level in critically ill patients, like enteral nutrition, insulin therapy, and continuous glucose monitoring. Among these, insulin therapy is used most commonly in critically ill patients. A range of 140 to 180 mg/dL is considered normal in critically ill patients.
