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Spring 2006

High Blood Sugar Treated Aggressively in Intensive Care

Recent studies showing that elevated blood sugar levels pose a health risk to patients in hospital intensive care units (ICU) have led to changes in the way these patients are treated. "The traditional philosophy was that a high blood sugar in ICU patients was simply the body's response to the stress of the illness, and it was not of much concern," says Archana Sadhu, M.D., UCLA endocrinologist. "Now we know that patients who are treated for this stress response fare better than those who are not."
Research shows that treating ICU patients with intravenous insulin therapy for their hyperglycemia (high blood sugar) results in dramatic reductions in mortality, sepsis and infections, and kidney failure, and reduced time spent on ventilators and in the ICU. The advantages were found regardless of whether patients had been previously diagnosed with diabetes, and were particularly pronounced among patients following surgery. Based on these large studies, professional societies have issued guidelines on tightly controlling blood sugars for hospitalized patients.

For non-diabetic patients whose elevated blood sugar levels require insulin treatment, the stress response typically goes away with time, and the patient can be weaned off the therapy by the time he or she leaves the hospital. On the other hand, some patients come as borderline cases, and their diabetes may be diagnosed for the first time in the ICU; early treatment of such patients improves their long-term prognosis.
"This has become an important aspect of a patient's care in the intensive care unit," says Dr. Sadhu. "We're learning a lot more about what it means for hospitalized patients to be hyperglycemic. We're being very aggressive with insulin therapy, and we're hoping to catch early diabetes as well as to improve the clinical outcomes of all of these patients."

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