Early hypoglycaemia and hyperglycaemia and 'tight' glycaemic control with and without glucose infusions

Excerpt

'Tight' glycaemic control in perioperative or critical ill patients may carry the risk of hypoglycaemia. However, a blood glucose target of 4.5–6.1 mmol/l has been shown to benefit critically ill, mainly postcardiothoracic surgery patients where, unusually, all patients were given glucose infusions from admission (200–300 g/24 hours). Of the 'tight' group, 5.2% had inconsequential hypoglycaemic episodes (blood glucose <2.2 mmol/l). The perceived risk of hypoglycaemia in starved patients receiving insulin to achieve 'tight' glycaemic control is a widespread concern. We report safety monitoring in our ongoing prospective, double-blind, randomised controlled study (the Does Additional Glucose Make A Difference? trial) investigating whether initial additional glucose infusion improves outcome in critical care patients receiving a 'tight' glycaemic control. Patients received 50% glucose or 0.9% NaCl at 20 ml/hour until full nutrition was taken. We monitored for excess hypoglycaemic episodes in our NaCl group. We set a 5% acceptable incidence of blood glucose <3.0 mmol/l and 0% for adverse consequences. …