Intensive Insulin Therapy as Therapeutic Strategy for Non-diabetic Hyperglycemia After Surgery in ICU
Intensive Insulin Therapy as Therapeutic Strategy for Non-diabetic Hyperglycemia After Surgery in ICU
The current study hypothesizes that the use of Intravenous intensive insulin therapy (IV-IIT)
 may be beneficial than IV conventional insulin therapy (IV-CIT) for improving the outcome of
 non-diabetic surgical patients had postoperative (PO) stress hyperglycemia (PSH).
All postoperative patients who will be admitted to surgical ICU and develop (PSH) will be
 eligible for evaluation for inclusion and exclusion criteria.

 Prior to initiation of IV-IT (insulin therapy), blood samples will be obtained to estimate
 base-line Blood Glucose level (BG). BG will be estimated hourly during IV-IT to guard against
 development of hypoglycemic episodes. The assigned IV-IT will continue till reaching the
 target BG for each group and then will be stopped and patients will be shifted to
 subcutaneous (sc)-IT. During maintenance sc-IT, BG level will be estimated 6-hourly to assure
 maintenance of BG within the desired range, otherwise if hyperglycemia recurred or its
 induced complications as hyperglycemic ketoacidosis or hyperosmolar coma or infectious
 complications developed, IV-IT will be resumed and BG will be followed-up hourly. The same
 sequence of follow-up will be continued till stability of BG at the targeted level. IV-IT
 will be provided as following :

 Conventional insulin therapy (CIT) will be provided as a continuous infusion of 50 IU of
 Actrapid HM in 50 ml of 0.9% sodium chloride using a pump. Infusion will be adjusted to
 achieve BG level in range of 180-200 mg/dl.

 Intensive insulin therapy (IIT) will be provided as an insulin infusion at rate of 1
 mU/kg/min and will be adjusted to achieve target BG level in range of 80-110 mg/dl.
Inclusion Criteria:

 -  All postoperative patients who will be admitted to surgical ICU and developed Post
 Surgical Hyperglycemia will be eligible for evaluation for inclusion and exclusion
 criteria

 Exclusion Criteria:

 -  All patients having diabetes mellitus, history of preoperative stress hyperglycemia,
 endocrinopathies, obesity defined as body mass index (BMI) >30 kg/m2, age younger than
 18 years, renal impairment or maintenance on renal replacement therapy and liver
 diseases.