Hypoglycemia Prevention by Algorithm Design During Intravenous Insulin Infusion

  • Susan Shapiro Braithwaite
  • Lisa P. Clark
  • Thaer Idrees
  • Faisal Qureshi
  • Oluwakemi T. Soetan
Hospital Management of Diabetes (A Wallia and JJ Seley, Section Editors)
  • 57 Downloads
Part of the following topical collections:
  1. Topical Collection on Hospital Management of Diabetes

Abstract

Purpose of Review

This review examines algorithm design features that may reduce risk for hypoglycemia while preserving glycemic control during intravenous insulin infusion. We focus principally upon algorithms in which the assignment of the insulin infusion rate (IR) depends upon maintenance rate of insulin infusion (MR) or a multiplier.

Recent Findings

Design features that may mitigate risk for hypoglycemia include use of a mid-protocol bolus feature and establishment of a low BG threshold for temporary interruption of infusion. Computer-guided dosing may improve target attainment without exacerbating risk for hypoglycemia. Column assignment (MR) within a tabular user-interpreted algorithm or multiplier may be specified initially according to patient characteristics and medical condition with revision during treatment based on patient response.

Summary

We hypothesize that a strictly increasing sigmoidal relationship between MR-dependent IR and BG may reduce risk for hypoglycemia, in comparison to a linear relationship between multiplier-dependent IR and BG. Guidelines are needed that curb excessive up-titration of MR and recommend periodic pre-emptive trials of MR reduction. Future research should foster development of recommendations for “protocol maxima” of IR appropriate to patient condition.

Keywords

Hypoglycemia Critical care Insulin protocol Insulin infusion Best practices Critical care protocols 

Abbreviations

BG

Blood glucose

CGM

Continuous glucose monitoring

ICU

Intensive care unit

IR

Infusion rate of insulin

IV

Intravenous

MR

Maintenance rate of insulin infusion

Notes

Compliance with Ethical Standards

Conflict of Interest

Susan Shapiro Braithwaite has a patent for an insulin algorithm which has not yet been embodied as a device (U.S. Patent No. 8,721,584 issued). She is on the Editorial Board for Endocrine Practice, as an Associate Editor. She also receives honoraria form the American Diabetes Association for book reviews.

Lisa P. Clark, Thaer Idrees, Faisal Qureshi, and Oluwakemi T. Soetan declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Susan Shapiro Braithwaite
    • 1
    • 2
  • Lisa P. Clark
    • 3
  • Thaer Idrees
    • 4
  • Faisal Qureshi
    • 5
  • Oluwakemi T. Soetan
    • 4
  1. 1.WilmetteUSA
  2. 2.Endocrinology Consults and Care, S.CChicagoUSA
  3. 3.Presence Saint Francis HospitalEvanstonUSA
  4. 4.Presence Saint Joseph HospitalChicagoUSA
  5. 5.Presence Saint Joseph HospitalChicagoUSA

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