Tight Glucose Control in the Hospital

How Important is tight glucose control while you are in the hospital ?

Most everyone with diabetes knows how important tight glucose control is. However, many are concerned with their hospital health care professionals who are not overly concerned with their glucose levels during their stay.
Even today, most scientists don’t know what the best glucose levels are for hospitalized patients with or without diabetes. Recent studies have looked into the question of whether the possible damage from hypoglycemia from intensive insulin therapy is more harmful than any caused by a temporary period of too high glucose levels.
The study in March 2009 compared glucose levels in the ICU of patients with Type 1 and Type 2 diabetes, along with non-diabetics because severely sick patients have a rise in glucose levels. Half of the patients were put on a strict glucose goal of 81-108mg/dl. The other half had a target of 180mg/dl or less.
Ninety days later, it was found that the intensive control group had a 14% higher death rate than the less controlled group. The researchers concluded that intensive glucose control in the ICU is putting patients at an increased risk of severe hypoglycemia and the risk of dying within 90 days. Therefore, they advise against tight glucose control in the ICU.
Other studies have shown no greater death rate, but a 6-fold increase in the risk of severe hypoglycemia. Neither study supports the current guidelines for use of insulin therapy in the ICU .
In another study, in individuals with diabetes who were hospitalized for various reasons, low blood sugar occurred in approximately 8% of the patients. Each additional day with a hypoglycemic episode was linked with an 85% increase in the risk of death while hospitalized.
If you plan on being in the hospital, it is recommended that you ask your doctor what kind of control he wants you to maintain during your stay, and make sure he conveys that to the hospital staff.
(Diabetes Self-Management Sept/Oct 2009,Pharmacy Times Sept 2009)