Blood Glucose Control in Critical Care

Acute hyperglycemia is a common condition in critically ill patients. Using intensive insulin therapy to normalize blood glucose in these patients is not recommended because of the high risk of hypoglycemia and evidence of harm from a large multicenter, multinational randomized controlled trial. In addition, previous belief that normoglycemia reduces the incidence of acute renal injuries and intensive care unit (ICU)-acquired infections has been refuted by several randomized trials. Therefore, based on available evidence and consensus guidelines, it is justified to recommend insulin infusion when blood glucose is above 180 mg/dL (10 mmol/L) and adjust the dose to target a blood glucose concentration between 108 and 180 mg/dL (6-10 mmol/L). However, emerging evidence suggests that patients with diabetes with poor premorbid glycemic control may benefit from more liberal glucose targets in ICU. The best approach to glucose management in patients with diabetes must be explored in future trials.