Managing Hypoglycemia Managing Hypoglycemia & Hyperglycemia& Hyperglycemia
RISK FACTORSRISK FACTORS
HYPOGLYCEMIA HYPERGLYCEMIA
DiabetesMedication Adverse
EffectsMedication
InteractionsContinuous Renal
Replacement TherapySepsisNutrition Imbalance
DiabetesMedication Adverse
EffectsMedication
InteractionsSepsisStress InducedNutrition Imbalance
Effective glucose control in the intensive care unit (ICU) has been shown to decrease morbidity across a large range of conditions and also to decrease mortality (IHI,2009).
TIGHT GLYCEMIC CONTROL TIGHT GLYCEMIC CONTROL IN CRITCALLY ILL ADULTSIN CRITCALLY ILL ADULTSTarget range is 80-110Hyperglycemic patients are
started on a Regular Insulin drip titrated depending on blood glucose levels.
Blood glucose levels are check every hour
Each institution has a protocol with guidelines for titration
Managing Hypoglycemia Managing Hypoglycemia Blood glucose less than 70 or per
hospital policy/protocolFirst assess the patient to see if
they exhibit symptoms ex: change in mental status, irritability.
Medication usually given are:1. Orange juice orally followed by a snack2. Glucagon IM or IV3. Dextrose 50% IV (most common in ICU)
Managing HyperglycemiaManaging HyperglycemiaPRN sliding scale with fast acting
Regular or Aspart insulin is used mostly for Diabetics Ex. If blood glucose 200-249 Give 2 units Regular insulin SQ
Longer acting insulin (NPH, Levemir, Lantus) is usually administered daily
For tight glycemic control or critically abnormal high (>400) glucose levels, continuous Regular insulin IV is given
REVIEWREVIEWHypoglycemia is a priority issue
and is mostly managed with D50 IVHyperglycemia is equally
important and is managed with insulin.
Only regular insulin is administered IV
It’s important to monitor blood glucose levels as well as assess the patient.