Control of blood sugar level on our unit

Why control blood glucose?
•Van Den Berghe study, Belgium, 2001, (110mg/dl).
•Van Den Berghe study, Belgium, 2003, high insulin therapy- mortality.
•BHF, Dr Finney, Oct. 2003, JAMA, for Insulin therapy.
•Laver et al, 2004, (Royal United Hosp, Bath), first paper in UK on protocols for BM control.

Methods
•Aim- To check how we were doing on our HDU/ ITU.
•Maximum and minimum blood sugar and insulin doses used over 24 hours.
•Mixed medical & surgical cases.
•Data collected over Sep-Oct. 2004.


Data
•152 audited*
•Diabetic-24
•Non diabetic-128
•145 fed/7 not fed
•Insulin- 112,
•DM- 21
Non DM- 89.


Maximum blood sugar levels

Minimum blood sugar levels

Percentage of patients, max. sugars.

Insulin therapy*

High dose Insulin therapy

High dose insulin*

Conclusions
•>10 BM- Not bad ( esp. for non DM).
•4-8 BM- Just under 50 % of total, all Non DM.
•Main bulk outside this range- BM 8-10, (50% DM, 23% Non DM).
•>10 BM- 50% DM lie above 10.
•We have a scope for improvement in BM 8-10 group.
•Further scope for control of even higher BM level groups, with insulin dose adjustments.

Recommendations
•For us- We can look at BM as if its a vital parameter, during daily ward rounds*.
•For nurses- Regular reinforcement of the protocols for BM control.
•Recheck the outcome after implementing these suggestions.