The major interventional trials of intensive insulin therapy in critically ill patients have reached divergent results. The present viewpoint article explores some of the potential reasons, including differences in monitoring technology and protocol design and performance, the occurrence of severe hypoglycemia and changes in the standard of care since publication of the landmark single-center t...

BACKGROUND Intensive glycaemic control can reduce the risk of microvascular complications in people with type 2 diabetes. AIM To examine the extent of monitoring and glycaemic control of patients with type 2 diabetes prescribed oral agents and/or insulin, and to investigate transition to insulin. DESIGN OF STUDY Retrospective cohort study. SETTING A total of 154 general practices in the U...

OBJECTIVE To measure clinical and qualitative outcomes in patients with diabetes mellitus transitioning from intensive insulin therapy using multiple daily injections (MDI) to continuous subcutaneous insulin infusion (CSII) initiated and managed by clinical pharmacists under a collaborative practice agreement in a primary care setting without an endocrinologist. RESEARCH DESIGN AND METHODS Th...

INTRODUCTION Critically ill patients requiring intensive care uniformly develop insulin resistance. This is most pronounced in patients with sepsis. Recently, several hormones secreted by adipose tissue have been identified to be involved in overall insulin sensitivity in metabolic syndrome-related conditions. However, little is known about these adipokines in critical illness. METHODS We stu...

Historical Background 461 Types of Insulin 461 Rapid-Acting Insulins 461 Intermediate-Acting Insulins 462 Long-Acting Insulins 462 Insulin Purity, Species, and Concentration 463 Beef and Pork Insulins 463 Human Insulin 463 Insulin Concentrations 464 Initiation of Insulin Therapy 464 Coals of Therapy 465 Treatment Strategies 466 Single-Dose Regimens 466 Twice-Daily Regimens 467 Multiple Daily In...

based patients may have even more variable glucose levels due to the intermittent nature of their caloric intake, in contrast to the continuous feeding that occurs commonly in critical care. The compounding effects of gluco-corticoid treatment, frequently used in patients with COPD, have already been highlighted. Insulin infusions carry a risk of inadvertent hypoglycaemia which increases as blo...

Question: Is the use of intensive insulin therapy compared with conventional therapy (on the basis of Leuven titration protocol) and hydroxyethyl starch (HES) compared with Ringer lactate effective and safe in patients with severe sepsis or septic shock? Design: Randomized open-label controlled trial. Setting: Multicentre (18 aca demic tertiary hospitals in Germany). Patients: Six hundred patie...