Blood sugar control in the intensive care unit: time to relook

Abstract

The choice of blood sugar control technique in the ICU has long been debated. Intensive insulin therapy to achieve normoglycaemia has been shown to reduce mortality, morbidity and the length of ICU stay; but, at the same time it also requires frequent glucose monitoring, adjustment of insulin dose and increase in the medical personnel workload. Despite its clinical benefits, intensive glucose control (IGT) is, however, not favoured by the intensivist, because of the risk of hypoglycaemia. This article provides the reader with an interesting thought: Can intensive blood sugar control be implemented in the ICU, while avoiding hypoglycaemia, and without an increase in hospital cost, and thus change existing blood sugar control protocols in the ICU? Is this possible with the use of continuous glucose monitoring (CGM) devices, which have recently emerged as a tool to maintain proper glucose levels? If further developed, CGM technology could ultimately prove clinically useful in the ICU. However, further research is warranted to confirm its benefits in the implementation of tight glucose control policies in the ICU.

Key words: blood glucose, continuous glucose monitoring, intensive care, intensive glucose control.