Maintaining Blood Glucose Levels in Range (70–150 mg/dL) is Difficult in COVID-19 Compared to Non-COVID-19 ICU Patients—A Retrospective Analysis

Beta cell dysfunction is suggested in patients with COVID-19 infections. Poor glycemic control in ICU is associated with poor patient outcomes. This is a single center, retrospective analysis of 562 patients in an intensive care unit from 1 March to 30 April 2020. We review the time in range (70–150 mg/dL) spent by critically ill COVID-19 patients and non-COVID-19 patients, along with the daily insulin use. Ninety-three in the COVID-19 cohort and 469 in the non-COVID-19 cohort were compared for percentage of blood glucose TIR (70–150 mg/dL) and average daily insulin use. The COVID-19 cohort spent significantly less TIR (70–150 mg/dL) compared to the non-COVID-19 cohort (44.4% vs. 68.5%). Daily average insulin use in the COVID-19 cohort was higher (8.37 units versus 6.17 units). ICU COVID-19 patients spent less time in range (70–150 mg/dL) and required higher daily insulin dose. A higher requirement for ventilator and days on ventilator was associated with a lower TIR. Mortality was lower for COVID-19 patients who achieved a higher TIR.

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The Initial Assessment of Daily Insulin Dose in Chinese Newly Diagnosed Type 2 Diabetes

Journal of Diabetes Research ◽

10.1155/2016/7245947 ◽

2016 ◽

Vol 2016 ◽

pp. 1-4 ◽

Cited By ~ 1

Author(s):

Jing Ma ◽

Huan Zhou ◽

Hua Xu ◽

Xie Chen ◽

Xiangyu Teng ◽

...

Keyword(s):

Type 2 Diabetes ◽

Blood Glucose ◽

Glucose Level ◽

Insulin Infusion ◽

Insulin Dose ◽

Newly Diagnosed ◽

Daily Insulin ◽

Daily Insulin Dose ◽

New Onset

Background. It has been well accepted that insulin therapy is the ideal treatment for newly diagnosed diabetic patients. However, there was no study about assessment of the initial insulin dosage in new onset Chinese patients with type 2 diabetes.Research Design and Methods. 65 newly diagnosed patients with type 2 diabetes (39 males/26 females; HbA1c ≥ 11.80 ± 0.22%) were investigated. All patients had random hyperglycaemia (at 21.8 ± 3.9 mmol/L) on the first day of admission and received insulin infusion intravenously (5 U/per hour). When the blood glucose level dropped to around 10 mmol/L, patients were then transferred to continuous subcutaneous insulin infusion (CSII). The reduction of blood glucose levels in response to per unit of insulin (RBG/RI) was recorded. The target glucose level was achieved in about 3 days. The total daily insulin dose (TDD) and basal insulin dose (TBD) were calculated.Results. TDD was 45.97 ± 1.28 units and TBD was 19.00 ± 0.54 units. TBD was about 40% of the total daily insulin requirement. There was a negative correlation between the ratio of RBG/RI and TDD.Conclusions. TDD was correlated with blood glucose reduction in response to intravenous insulin infusion in Chinese new onset patients with type 2 diabetes.

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The Prognostic Value of Admission Blood Glucose Levels in Nigerian Patients with Stroke: A 10-year Retrospective Analysis

Tropical Doctor ◽

10.1177/004947550403400324 ◽

2004 ◽

Vol 34 (3) ◽

pp. 184-185 ◽

Cited By ~ 1

Author(s):

A O Ogunrin ◽

E Unuigbe ◽

A Eregie ◽

E Amu ◽

A Isah ◽

...

Keyword(s):

Blood Glucose ◽

Retrospective Analysis ◽

Prognostic Value ◽

Glucose Levels ◽

Blood Glucose Levels

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Mobile-based insulin dose adjustment for type 2 diabetes in community and rural populations: study protocol for a pilot randomized controlled trial

Therapeutic Advances in Endocrinology and Metabolism ◽

10.1177/2042018819836647 ◽

2019 ◽

Vol 10 ◽

pp. 204201881983664 ◽

Cited By ~ 2

Author(s):

Anish Menon ◽

Leonard Gray ◽

Farhad Fatehi ◽

Dominique Bird ◽

Darsy Darssan ◽

...

Keyword(s):

Blood Glucose ◽

Dose Adjustment ◽

Controlled Trial ◽

Insulin Dose ◽

Community Outreach ◽

Routine Care ◽

Glucose Levels ◽

Blood Glucose Levels ◽

Pilot Randomized Controlled Trial

Background: Insulin initiation and/or titration for type 2 diabetes (T2DM) is often delayed as it is a resource-intensive process, often requiring frequent exchange of information between a patient and their diabetes healthcare professional, such as a credentialed diabetes educator (CDE) for insulin dose adjustment (IDA). Existing models of IDA are unlikely to meet the increasing service demand unless efficiencies are increased. Mobile health (mHealth), a subset of Ehealth, has been shown to improve glycaemic control through enhanced self-management and feedback leading to improved patient satisfaction and could simultaneously reduce costs. Considering the potential benefits of mHealth, we have developed an innovative mHealth-based care model to support patients and clinicians in diabetes specialist community outreach and telehealth clinics, that is, REthinking Model of Outpatient Diabetes care utilizing EheaLth – Insulin Dose Adjustment (REMODEL-IDA). This model primarily aims to improve the glycaemic management of patients with T2DM on insulin, with the secondary aims of improving healthcare service delivery efficiency and the patients’ experience. Methods/Design: A two-arm pilot randomized controlled trial (RCT) will be conducted for 3 months with 44 participants, randomized at a 1:1 ratio to receive either the mHealth-based model of care (intervention) or routine care (control), in diabetes specialist community outreach and telehealth clinics. The intervention arm will exchange information related to blood glucose levels via the Mobile Diabetes Management System developed for outpatients with T2DM. They will receive advice on insulin titration from the CDE via the mobile-app and receive automated text-message prompts for better self-management based on their blood glucose levels and frequency of blood glucose testing. The routine care arm will be followed up via telephone calls by the CDE as per usual practice. The primary outcome is change in glycated haemoglobin, a marker of glycaemic management, at 3 months. Patient and healthcare provider satisfaction, and time required to perform IDA by healthcare providers in both arms will be collected. This pilot study will guide the conduct of a large-scale pragmatic RCT in regional Australia.

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Improvement of Glucose Control in the Intensive Care Unit: An Interdisciplinary Collaboration Study

American Journal of Critical Care ◽

10.4037/ajcc2008.17.2.150 ◽

2008 ◽

Vol 17 (2) ◽

pp. 150-156 ◽

Cited By ~ 9

Author(s):

Ulrike Holzinger ◽

Monika Feldbacher ◽

Adelbert Bachlechner ◽

Reinhard Kitzberger ◽

Valentin Fuhrmann ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Blood Glucose ◽

Glucose Control ◽

Care Staff ◽

Diabetic Patients ◽

Control Protocol ◽

Glucose Levels ◽

Blood Glucose Levels ◽

Insulin Use

Background Strict glycemic control in critically ill patients is challenging for both physicians and nurses. Objectives To determine the effect of focused education of intensive care staff followed by implementation of a glucose control protocol. Methods A prospective observational study in a medical intensive care unit in a university hospital. After intensive education of nurses and physicians, a glucose control protocol with a nurse-managed insulin therapy algorithm was developed and implemented. Every measured blood glucose value and insulin dose per hour and per day were documented in 36 patients before and 44 patients after implementation of the protocol. Results Median blood glucose levels decreased after implementation of the protocol (133 vs 110 mg/dL; P < .001). The amounts of time when patients’ blood glucose levels were less than 110 mg/dL and less than 150 mg/dL increased after implementation of the protocol (8% vs 44%; 75% vs 96%; P<.001). The median use of insulin increased after implementation of the protocol (28 vs 35 IU/day; P=.002). Diabetic patients had higher median blood glucose levels than did nondiabetic patients both before (138 vs 131 mg/dL) and after (115 vs 108 mg/dL; P<.001) implementation, although median insulin use also increased (before implementation, 33 vs 26 IU/day; P=.04; after implementation, 46 vs 30 IU/day; P < .001). Conclusions Use of a collaboratively developed glucose control protocol led to decreased median blood glucose levels and to longer periods of normoglycemia. Despite increased insulin use, glucose control was worse in diabetic patients.

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Insulin Requirements in the Intensive Care Unit in Response to Infection

The American Surgeon ◽

10.1177/000313480807400916 ◽

2008 ◽

Vol 74 (9) ◽

pp. 845-848 ◽

Cited By ~ 2

Author(s):

Nell Maloney ◽

Rebecca C. Britt ◽

Gregory D. Rushing ◽

Scott F. Reed ◽

Fredric C. Cole ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Blood Glucose ◽

Elevated Temperature ◽

Blood Cell ◽

Cell Count ◽

Insulin Dose ◽

Blood Cell Count ◽

Glucose Levels ◽

Blood Glucose Levels

Infectious complications in the intensive care unit (ICU) are classically identified when an elevated temperature triggers obtaining cultures. Elevated temperature, however, is a nonspecific marker of infection and may occur well into the course of the infection. The goal of this study was to evaluate whether escalating insulin demands may serve as an earlier marker for infection. A retrospective review of a prospective database from a trauma ICU over a 6-month period was done for all patients who developed infection while in the ICU. All patients in the ICU are placed at admission on an intensive insulin protocol with target blood glucose levels between 80 and 110 mg/dL. Data were collected on infection, insulin needs, blood glucose levels, temperature, white blood cell count, and antibiotic use. Twenty-four infections were identified, with 16 pneumonias, four bloodstream infections, and four urinary tract infections. Twelve of the 24 patients had increasing insulin needs in the 3 days preceding their infection diagnosis, with nine of the 12 requiring continued escalation of insulin needs from preinfection Day 3 to 2 to 1 (D3, D2, D1). In five of the 12 patients, the escalation of insulin dose preceded the elevated temperature, and in three of the 12 patients, the escalation preceded elevation of the white blood cell count above 12. For all 24 patients, the average insulin dose increased steadily, from 1.8 U/hr on D3 preinfection to 2.5 U/hr D2 and 3.1 U/hr D1. Infection does seem to be preceded by escalating insulin demands in many patients. A prospective study to evaluate the value of increased insulin demand as a marker for developing infection is warranted.

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Ameliorative potential of Blighia sapida K.D. Koenig bark against pancreatic β-cell dysfunction in alloxan-induced diabetic rats

Journal of Complementary and Integrative Medicine ◽

10.1515/jcim-2016-0145 ◽

2017 ◽

Vol 14 (3) ◽

Cited By ~ 7

Author(s):

Oluwafemi Adeleke Ojo ◽

Basiru Olaitan Ajiboye ◽

Adebola Busola Ojo ◽

Babatunji Emmanuel Oyinloye ◽

Oluwatosin Debbie Imiere ◽

...

Keyword(s):

Body Weight ◽

Blood Glucose ◽

West Africa ◽

Intraperitoneal Injection ◽

Diabetic Rats ◽

Pancreatic Β Cell ◽

Β Cell ◽

Glucose Levels ◽

Cell Dysfunction ◽

Blood Glucose Levels

AbstractBackgroundIn West Africa, the fruit, seed, leaf and stem ofMethodsDiabetes was induced by intraperitoneal injection of alloxan (65 mg/kg body weight) for 21 days, and orally administered with glibenclamide (5 mg/kg body weight), 50–150 mg/kg body weight ofResultsThe blood glucose levels of rats induced with alloxan were significantly and gradually reduced (p<0.05) inConclusionsThese findings indicate that

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Multiple daily insulin injections ameliorate QT interval by lowering blood glucose levels in patients with type 2 diabetes

Therapeutic Advances in Endocrinology and Metabolism ◽

10.1177/20420188211010057 ◽

2021 ◽

Vol 12 ◽

pp. 204201882110100

Author(s):

Shunsuke Kobayashi ◽

Mototsugu Nagao ◽

Izumi Fukuda ◽

Shinichi Oikawa ◽

Hitoshi Sugihara

Keyword(s):

Type 2 Diabetes ◽

Blood Glucose ◽

Sudden Cardiac Death ◽

Qt Interval ◽

Cardiac Death ◽

Glucose Levels ◽

Daily Insulin ◽

Blood Glucose Levels ◽

Multiple Daily Insulin Injections

Background: A prolonged QT interval plays a causal role in fatal arrhythmia and is known to be a risk factor for sudden cardiac death. Although diabetic patients with microvascular complications tend to have a longer QT interval, the therapeutic effect of diabetes on the QT interval remains unclear. Here, we assessed the changes in QT interval in patients with type 2 diabetes (T2D) who received multiple daily insulin injections. Materials and methods: Patients with T2D ( n = 34) who were admitted to our hospital and initiated multiple daily insulin injections for glycemic control were enrolled in this study. Clinical measurements, including electrocardiogram, were taken on admission and discharge. The QT interval was measured manually in lead II on the electrocardiogram, and corrected QT interval (QTc) was calculated using Bazett’s formula. The change in QTc (ΔQTc) during hospitalization (median, 15 days) and clinical parameters affecting ΔQTc were investigated. Results: QTc was shortened from 439 ± 24 to 427 ± 26 ms during hospitalization ( p < 0.0001). ΔQTc was positively correlated with the changes in fasting plasma glucose (ΔFPG, r = 0.55, p = 0.0008) and glycated albumin ( r = 0.38, p = 0.026) following insulin therapy, but not with the final dose of insulin ( r = −0.20, p = 0.26). The multiple regression analyses revealed that ΔFPG was independently associated with ΔQTc. Conclusions: Multiple daily insulin injections can ameliorate QT interval by lowering the blood glucose levels in T2D, suggesting that glycemic control is important for preventing patients with T2D from sudden cardiac death.

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Challenges in management of transient hyperinsulinism – a retrospective analysis of 36 severely affected children

Journal of Pediatric Endocrinology and Metabolism ◽

10.1515/jpem-2020-0639 ◽

2021 ◽

Vol 0 (0) ◽

Author(s):

Henrike Hoermann ◽

Marcia Roeper ◽

Roschan Salimi Dafsari ◽

Felix Koestner ◽

Christina Reinauer ◽

...

Keyword(s):

Blood Glucose ◽

Retrospective Analysis ◽

Blood Glucose Measurement ◽

Glucose Measurement ◽

Intravenous Glucose ◽

Glucose Levels ◽

Blood Glucose Levels ◽

Lower Blood ◽

Subsequent Episode ◽

The University

Abstract Objectives Transient hyperinsulinism (THI) is a hypoglycemia disorder which resolves spontaneously within the first weeks or months of life. The pathomechanism of THI is not elucidated yet; however, it is known that perinatal stress predisposes for THI. We aimed to characterize the clinical phenotype and treatment of children with THI, and to identify options for improved management. Methods A retrospective analysis of 36 children with THI treated at the University Children’s Hospital Düsseldorf between 2007 and 2019 was performed. Results All children had risk factors for neonatal hypoglycemia or indicators of perinatal stress. Eighty three percent were diagnosed with hypoglycemia on day of life (DOL)1. None of the six diagnosed later had routine blood glucose screening and showed significantly lower blood glucose levels at the time of first blood glucose measurement compared to the children diagnosed on DOL1. Ninety seven percent of all children received intravenous glucose, 42% received continuous glucagon and 81% were started on diazoxide. Diazoxide withdrawal and subsequent fasting tests lacked standardization and were based on clinical experience. Three patients had a subsequent episode of hypoglycemia, after fasting studies only demonstrated “clinical” remission without proving the ability to ketogenesis. Conclusions Any kind of perinatal stress might pose a risk to develop THI, and postnatal monitoring for hypoglycemia still needs to be improved. Diazoxide is effective in children with THI; however, further studies are needed to guide the development of criteria and procedures for the initiation and discontinuation of treatment. Furthermore, establishing consensus diagnostic criteria/definitions for THI would improve comparability between studies.

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