Inpatient insulin therapy |
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| Institution: | 1. Physics Department, Athens University, Athens, Greece;2. Dipartamento di Fisica, Universitá di Bari, and INFN, Bari, Italy;3. Institute of Nuclear Physics, Krakow, Poland;4. CERN, CH-1211 Geneva 23, Switzerland;5. Fakultät für Physik, Universität Freiburg, D-7899 Freiburg, Germany;6. Gesellschaft für Schwerionenforschung, D-6100 Darmstadt 11, Germany;7. Institut für Hochenergiephysik, Universität Heidelberg, D-6900 Heidelberg 1, Germany;8. Fachbereich Physik, Universität Frankfurt, D-6000 Frankfurt, Germany;9. Lawrence Berkeley Laboratory, Berkeley CA 94720, USA;10. Fachbereich Physik, Universität Marburg, D-3550 Marburg, Germany;11. Max-Planck-Institut für Physik, D-8000 München, Germany;12. University of Njimegen, Njimegen, Netherlands;13. Institute of Experimental Physics, Warsaw University, Warsaw, Poland;14. Insitute of Nuclear Studies, Warsaw, Poland;15. R. Boskovic Institute, Zagreb, Yugoslavia;1. Department of Psychosomatic Medicine and Psychotherapy, University of Heidelberg, Central Institute of Mental Health, Mannheim, Germany;2. Department of Cognitive and Clinical Neuroscience, University of Heidelberg, Central Institute of Mental Health, Mannheim, Germany;3. Department of Clinical Psychology, Johannes-Gutenberg-University, Mainz, Germany;4. Institute of Physiology und Pathophysiology, Johannes-Gutenberg-University, Mainz, Germany |
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| Abstract: | Background: Many diabetic, as well as nondiabetic, hospitalized patients develop hyperglycemia. Numerous studies have demonstrated that critically ill, as well as noncritically ill, hospitalized patients who develop hyperglycemia are at increased risk for morbidity and mortality.Objective: The objective of this article was to review the risks associated with hyperglycemia in hospitalized patients, the biologic rationale for using insulin to prevent increases in glucose levels, and strategies for managing hyperglycemia in the hospital setting.Methods: We conducted a computerized search of biomedical journal literature from MEDLINE, PubMed, and Ovid published from 1994 to March 2008. We reviewed English-language original and review articles found under the subject headings “hospitalization and insulin therapy,” “inpatient diabetes and complications,” and “insulin and inflammation.”Results: More than 200 references were found during the literature search. According to the literature, the adverse outcomes that are associated with hyperglycemia may be attributed to the inflammatory and pro-oxidant effects of elevated glucose levels. The use of insulin, which has anti-inflammatory, vasodilatory, and antioxidant properties as well as the ability to inhibit lipolysis and platelet aggregation, can prevent many of these adverse outcomes.Conclusions: Hospitals should have protocols in place for using insulin to treat and prevent hyperglycemia. Subcutaneous insulin may be used for both purposes in most noncritically ill patients, whereas intravenous infusion of insulin is preferred in critically ill patients. |
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