Hyperglycemia and Insulin Management in Critically Ill Patients

Hyperglycemia is a leading cause of increased morbidity and mortality in critically ill diabetic and nondiabetic patients in the ICU. Stricter control should be implemented in this setting in order to reduce mortality as well as other complications caused by hyperglycemia. Because hypoglycemia is associated with an increased risk of adverse effects, the optimal intensity of glucose control has been extensively investigated. Hyperglycemia is better controlled through continuous glucose infusions than with intermittent injections or IV infusions because it is easier to titrate the concentration of insulin to achieve a target glucose range. Pharmacists in acute-care and ambulatory-care settings are able to adjust insulin therapy and educate patients about hypoglycemia or hyperglycemia in order to optimize patient outcomes.