Hyperglycemia often occurs after transition from intravenous insulin infusion (IVII) to subcutaneous insulin. Weight-based basal insulin initiated earlier in the course of the IVII in the MICU, and a weight-based basal-bolus regimen post-IVII, can potentially improve post-IVII glycemic control by 48 hours.
This prospective study included 69 MICU patients on IVII for 24+ hours. Exclusions were ESRD, T1DM, and active use of vasopressors. Intervention group received weight-based basal insulin (0.2-0.25 units/kg) with IVII and weight-based bolus insulin post IVII. The control group received current care. Primary endpoint was glucose at specific time intervals up to 48 hours post-IVII.
There were 25 patients in the intervention and 44 in the control. Mean age was 59 ± 15 years old, 47% were male, and 78% had prior DM. The two groups were not different (AKI/CKD, pre-existing DM, illness severity, or NPO status post IVII) except for steroid use, higher in the control arm (12% vs 34%). Glucose levels were not lower until 36-48 hours post-IVII (166.8 ± 39.1 mg/dLvs 220.0 ± 82.9 mg/dL, p <0.001). When controlling for BMI, nutritional status, HbA1c and steroid use, glucose was lower starting at 12-24 hours out (166.87 mg/dL vs 207.50 mg/dL, p=0.015). Hypoglycemia frequency was similar between groups (5.0% vs 7.1%). The study did not reach target enrollment.
Addition of weight-based basal insulin during, and basal-bolus insulin immediately after, IVII in the MICU results in better glycemic control at 24 hours post-IVII with no increased hypoglycemia.

Copyright © 2021. Published by Elsevier Inc.