🩸 Glucose Control in Critically Ill Patients
Glycemic targets and insulin-management direction for critically ill patients, avoiding both hyperglycemia and hypoglycemia.
Glucose Control in Critically Ill Patients
Current glucose
Unit
Population
When to use
Use in the ICU to select a blood-glucose target band and decide when to start IV insulin infusion, with attention to avoiding hypoglycemia.
How it works
Target generally 140–180 mg/dL (7.8–10.0 mmol/L) for most critically ill; start IV insulin infusion when glucose is persistently > 180 mg/dL; avoid tight control (80–110) due to hypoglycemia harm; monitor frequently.
Key points
- A moderate target (140–180 mg/dL) balances the harms of hyperglycemia against the hypoglycemia risk of tight control (original synthesis · not guideline verbatim).
- Tight glucose control (NICE-SUGAR) increased severe hypoglycemia and mortality, so it is no longer recommended.
- Frequent point-of-care monitoring and a validated infusion protocol reduce both hyper- and hypoglycemic excursions.
References
- NICE-SUGAR Investigators. Intensive vs conventional glucose control. N Engl J Med 2009.
- Surviving Sepsis Campaign 2021 — glycemic control.
Decision support for licensed clinicians only; not a substitute for clinical judgement, diagnosis or local protocols.