2.50
Hdl Handle:
http://hdl.handle.net/10755/157165
Category:
Abstract
Type:
Presentation
Title:
The Importance and Implications of Understanding Blood Glucose Variability
Author(s):
Reed, Charles; Kongable, Gail; Gerhardt, Susan; Beadle, Randy; Stewart, Ronald
Author Details:
Charles Reed, University Hospital, San Antonio, Texas, USA, email: charles.reed@uhs-sa.com; Gail Kongable; Susan Gerhardt; Randy Beadle; Ronald Stewart
Abstract:
PURPOSE: Stress-induced hyperglycemia has been associated with poor outcomes and death in critically ill patients. Blood glucose (BG) variability, a component of stress-related hyperglycemia has recently been reported as a significant independent predictor of intensive care unit and hospital mortality. We sought to evaluate the feasibility of using blood glucose variability as a possible predictor or warning sign for a worsening patient condition requiring intervention. Description: A convenience sample of three patients where the BG levels had stabilized on a consistent intravenous (IV) insulin dose rate for up to 20 hours in a surgical trauma intensive care unit was selected. Point-of-care BG values and other clinical measures were collected from the medical record of the three patients who received intensive insulin therapy. Data were collected manually and electronically using the Remote Automated Laboratory System-Tight Glycemic Control Module (RALS-TGCM) BG management and monitoring system. In each of these cases a critically ill, non-diabetic patient, requiring continuous IV insulin therapy for hyperglycemia exhibited increased BG variability. In each instance, BG variability was present in a worsening patient condition after a period of normalization of hyperglycemia with no other apparent causes or explanations for the increased hyperglycemia. Additionally, each patient required medical intervention during the hyperglycemic episode. EVALUATION: While decreasing the variability of blood glucose with intensive insulin therapy may be an important aspect of treatment for critical illness in general, acute episodes of glucose fluctuation may be interpreted as sentinel events which signal impending clinical worsening. These events warrant investigation of the underlying cause and potentially offer opportunity for earlier treatment to offset the patients' further decline. Further studies in variability in blood glucose concentration would reasonably include subgroup analyses to determine clinical conditions that place patients at most risk for these dangerous fluctuations.
Repository Posting Date:
26-Oct-2011
Date of Publication:
26-Oct-2011
Citation:
2009 National Teaching Institute Research Abstracts. American Journal of Critical Care, 18(3), e1-e17.
Conference Date:
2009
Conference Name:
National Teaching Institute and Critical Care Exposition
Conference Host:
American Association of Critical-Care Nurses
Conference Location:
New Orleans, Louisiana, USA
Note:
This is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.

Full metadata record

DC FieldValue Language
dc.type.categoryAbstracten_GB
dc.typePresentationen_GB
dc.titleThe Importance and Implications of Understanding Blood Glucose Variabilityen_GB
dc.contributor.authorReed, Charlesen_GB
dc.contributor.authorKongable, Gailen_GB
dc.contributor.authorGerhardt, Susanen_GB
dc.contributor.authorBeadle, Randyen_GB
dc.contributor.authorStewart, Ronalden_GB
dc.author.detailsCharles Reed, University Hospital, San Antonio, Texas, USA, email: charles.reed@uhs-sa.com; Gail Kongable; Susan Gerhardt; Randy Beadle; Ronald Stewarten_GB
dc.identifier.urihttp://hdl.handle.net/10755/157165-
dc.description.abstractPURPOSE: Stress-induced hyperglycemia has been associated with poor outcomes and death in critically ill patients. Blood glucose (BG) variability, a component of stress-related hyperglycemia has recently been reported as a significant independent predictor of intensive care unit and hospital mortality. We sought to evaluate the feasibility of using blood glucose variability as a possible predictor or warning sign for a worsening patient condition requiring intervention. Description: A convenience sample of three patients where the BG levels had stabilized on a consistent intravenous (IV) insulin dose rate for up to 20 hours in a surgical trauma intensive care unit was selected. Point-of-care BG values and other clinical measures were collected from the medical record of the three patients who received intensive insulin therapy. Data were collected manually and electronically using the Remote Automated Laboratory System-Tight Glycemic Control Module (RALS-TGCM) BG management and monitoring system. In each of these cases a critically ill, non-diabetic patient, requiring continuous IV insulin therapy for hyperglycemia exhibited increased BG variability. In each instance, BG variability was present in a worsening patient condition after a period of normalization of hyperglycemia with no other apparent causes or explanations for the increased hyperglycemia. Additionally, each patient required medical intervention during the hyperglycemic episode. EVALUATION: While decreasing the variability of blood glucose with intensive insulin therapy may be an important aspect of treatment for critical illness in general, acute episodes of glucose fluctuation may be interpreted as sentinel events which signal impending clinical worsening. These events warrant investigation of the underlying cause and potentially offer opportunity for earlier treatment to offset the patients' further decline. Further studies in variability in blood glucose concentration would reasonably include subgroup analyses to determine clinical conditions that place patients at most risk for these dangerous fluctuations.en_GB
dc.date.available2011-10-26T19:28:47Z-
dc.date.issued2011-10-26en_GB
dc.date.accessioned2011-10-26T19:28:47Z-
dc.identifier.citation2009 National Teaching Institute Research Abstracts. American Journal of Critical Care, 18(3), e1-e17.en_GB
dc.conference.date2009en_GB
dc.conference.nameNational Teaching Institute and Critical Care Expositionen_GB
dc.conference.hostAmerican Association of Critical-Care Nursesen_GB
dc.conference.locationNew Orleans, Louisiana, USAen_GB
dc.identifier.citation2009 National Teaching Institute Research Abstracts. American Journal of Critical Care, 18(3), e1-e17.en_GB
dc.description.noteThis is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.-
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