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.