Background: Many patients require IV insulin during their critical illness. Maintenance of insulin in St Jamess Hospital ICU is governed by a local protocol. At the time of ICU discharge, IV insulin therapy is often stopped. Transitioning from IV to subcutaneous insulin is often done with endocrinology input. If this is unavailable inappropriate insulin dosing may increase the risk of hypo-/hyperglycaemia.
Aims: To reduce the number of episodes of hyperglycaemia (BG>14), hypoglycaemia (BG<4.0) and diabetic emergencies over the first 48 h following ICU discharge in patients requiring IV insulin.
Methods: All patients requiring IV insulin over the previous 6 months were highlighted using the ICU electronic patient record. Those on IV insulin on their day of discharge were isolated. Medical records were analysed to record episodes of hypo/hyperglycaemia that occurred in the first 48 h following discharge from ICU. A protocol for transitioning from IV to SC insulin was then developed and implemented. Rates of hypo/hyperglycaemia were then recorded in this group. Rates of each were compared.
Results: From November 2018 to April 2019 262 patients required IV insulin during their ICU admission. 56 were on IV insulin on their day of discharge. 19 were excluded due to inadequate data. 56.7% (n=21) were hyperglycaemic , 2.7% (n=1) had an episode of symptomatic hypoglycaemia and 8.1% (n=3) had hyperglycaemia with ketosis within 48 h after ICU discharge. From May to June 2019 14 patients underwent IV to SC insulin transition using our protocol. 1 was excluded as the protocol was not adhered to. 7.1% (n=1) were hyperglycaemic over the 48 h following ICU discharge. There were no episodes of hypoglycaemia and no diabetic emergencies.
Discussion: This protocol appears to be safe and improves rates of hypo-/hyperglycaemia in a group of patients transitioning from a closed ICU to ward-based management.