5 Citations (Scopus)

Abstract

Glucose control improves outcomes in the hospitalized patient, particularly patients on prolonged ventilator support, after acute myocardial infarction or after coronary artery bypass surgery. An iv insulin algorithm is the standard of care for initial treatment of significant hyperglycemia in the hospitalized patient, and it can be transitioned to periodic sc insulin once the patient is more stable. However, illness, medications, the endocrine and inflammatory response to stress, and pain can all contribute to insulin resistance and further aggravate preexisting insulin resistance caused by obesity. Glucose treatment goals have been established to guide the1rapy, but achieving those goals can be more challenging in the presence of severe insulin resistance. When target glucose values are not achieved with established insulin algorithms, the practitioner should evaluate for potential causes of insulin resistance from technical factors that cause "pseudo-insulin resistance" as well as other modifiable factors,suchas electrolyte disorders, parenteralandenteral nutrition,orother medications. Published glucose guidelines provide glucose "goals" to guide changes in the insulin algorithm, but these goals may be difficult to achieve in all individuals. Weproposeastepwiseapproachto evaluateandtreat severe insulin resistance in the hospitalized patient in order to achieve glucose goals in a timely fashion.

Original languageEnglish (US)
Pages (from-to)2652-2662
Number of pages11
JournalJournal of Clinical Endocrinology and Metabolism
Volume96
Issue number9
DOIs
StatePublished - Sep 1 2011

Fingerprint

Insulin Resistance
Insulin
Glucose
Nutrition Disorders
R Factors
Mechanical Ventilators
Standard of Care
Coronary Artery Bypass
Hyperglycemia
Electrolytes
Obesity
Myocardial Infarction
Guidelines
Pain
Nutrition
Surgery
Therapeutics

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Biochemistry
  • Endocrinology
  • Clinical Biochemistry
  • Biochemistry, medical

Cite this

Approach to the hospitalized patient with severe insulin resistance. / Larsen, Jennifer Lynn; Goldner, Whitney S.

In: Journal of Clinical Endocrinology and Metabolism, Vol. 96, No. 9, 01.09.2011, p. 2652-2662.

Research output: Contribution to journalReview article

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