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Hypoglycemia Prevention by Algorithm Design During Intravenous Insulin Infusion

  • Hospital Management of Diabetes (A Wallia and JJ Seley, Section Editors)
  • Published:
Current Diabetes Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

This review examines algorithm design features that may reduce risk for hypoglycemia while preserving glycemic control during intravenous insulin infusion. We focus principally upon algorithms in which the assignment of the insulin infusion rate (IR) depends upon maintenance rate of insulin infusion (MR) or a multiplier.

Recent Findings

Design features that may mitigate risk for hypoglycemia include use of a mid-protocol bolus feature and establishment of a low BG threshold for temporary interruption of infusion. Computer-guided dosing may improve target attainment without exacerbating risk for hypoglycemia. Column assignment (MR) within a tabular user-interpreted algorithm or multiplier may be specified initially according to patient characteristics and medical condition with revision during treatment based on patient response.

Summary

We hypothesize that a strictly increasing sigmoidal relationship between MR-dependent IR and BG may reduce risk for hypoglycemia, in comparison to a linear relationship between multiplier-dependent IR and BG. Guidelines are needed that curb excessive up-titration of MR and recommend periodic pre-emptive trials of MR reduction. Future research should foster development of recommendations for “protocol maxima” of IR appropriate to patient condition.

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Abbreviations

BG:

Blood glucose

CGM:

Continuous glucose monitoring

ICU:

Intensive care unit

IR:

Infusion rate of insulin

IV:

Intravenous

MR:

Maintenance rate of insulin infusion

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Authors and Affiliations

  1. 1135 Ridge Road, Wilmette, IL, 60091, USA

    Susan Shapiro Braithwaite

  2. Endocrinology Consults and Care, S.C, 3048 West Peterson Ave, Chicago, IL, 60659, USA

    Susan Shapiro Braithwaite

  3. Presence Saint Francis Hospital, 355 Ridge Ave, Evanston, IL, 60202, USA

    Lisa P. Clark

  4. Presence Saint Joseph Hospital, 2900 N. Lakeshore Dr, Chicago, IL, 60657, USA

    Thaer Idrees & Oluwakemi T. Soetan

  5. Presence Saint Joseph Hospital, 2800 N Sheridan Road Suite 309, Chicago, IL, 60657, USA

    Faisal Qureshi

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  1. Susan Shapiro Braithwaite
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Correspondence to Susan Shapiro Braithwaite.

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Conflict of Interest

Susan Shapiro Braithwaite has a patent for an insulin algorithm which has not yet been embodied as a device (U.S. Patent No. 8,721,584 issued). She is on the Editorial Board for Endocrine Practice, as an Associate Editor. She also receives honoraria form the American Diabetes Association for book reviews.

Lisa P. Clark, Thaer Idrees, Faisal Qureshi, and Oluwakemi T. Soetan declare that they have no conflict of interest.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Hospital Management of Diabetes

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Braithwaite, S.S., Clark, L.P., Idrees, T. et al. Hypoglycemia Prevention by Algorithm Design During Intravenous Insulin Infusion. Curr Diab Rep 18, 26 (2018). https://doi.org/10.1007/s11892-018-0994-4

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