Tight glycaemic control: clinical implementation of protocols

Implementation of tight glycaemic control in hospitalised patients presents a huge challenge. It concerns many patients, there are many interfering factors and many health-care professionals are involved. The current literature provides little practical guidance. This article offers the clinical anesthesiologist direction for the organisation of inpatient blood glucose control in acute situations, in the perioperative setting and in the intensive care unit. An effective, safe and user-friendly algorithm for intravenous insulin administration is presented that can be executed by regular nurses and used in many situations. Practical advice is offered for the use of subcutaneous basal–bolus insulin, for fasting orders and for transition to discharge care. The main safety considerations are discussed.

Keywords: blood-glucose control, algorithms, protocols, tight glycaemic control, intensive-insulin therapy, critically ill patients