Inhospital morbidity and mortality are increased in hyperglycemia.
Normalization of blood glucose levels using intensive insulin infusion protocols
improves clinical outcomes. Insulin infusion algorithms have been shown to be
safe and effective; however, a major obstacle in their implementation is their
complexity. We have developed a novel pathway for the management of
hyperglycemia, which introduces the "wheel" concept for insulin dosing
complemented by "catchup" insulin dosing. The "wheel" serves as a treatment
guide. It is made up of 4 concentric circles. The inner circle features blood
glucose ranges and the 3 outer circles correspond to increasing rates of insulin
infusion. Simple guidelines are provided to facilitate conversion from insulin
infusion to a subcutaneous insulin-delivery regimen in preparation for transfer
from the critical care unit setting. Our protocols eliminate reliance on the
familiar "sliding scale" insulin administration schemes with the introduction of
"catchup" insulin dosing to supplement the basic regimen. This pathway is
comprehensive yet simple and provides guidelines for treatment of hyperglycemia
for all patients screened to a critical care unit or to a stepdown unit.