Metabolic inefficacy of a short-term low-dose insulin regimen in critically ill patients: a randomized, placebo-controlled trial

Hyperglycemia and protein catabolism frequently occur in critically ill patients and both are associated with increased complication rates. These metabolic alterations can be improved by insulin administered exogenously. Since a wide range of insulin dosages have been used, this randomized, placebo-...

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Bibliographic Details
Published in:Wiener Klinische Wochenschrift 2004-09, Vol.116 (17-18), p.603-607
Main Authors: Holzinger, Ulrike, Zauner, Alexandra, Nimmerrichter, Petra, Schiefermeier, Mark, Ratheiser, Klaus, Zauner, Christian
Format: Article
Language:English
Subjects:
Adult
Aged
Analysis of Variance
Blood Glucose - analysis
Critical Illness
Data Interpretation, Statistical
Enteral Nutrition
Female
Humans
Hyperglycemia - drug therapy
Infusions, Intravenous
Insulin - administration & dosage
Insulin - blood
Intensive Care Units
Male
Middle Aged
Parenteral Nutrition
Placebos
Proteins - metabolism
Safety
Time Factors
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Summary:Hyperglycemia and protein catabolism frequently occur in critically ill patients and both are associated with increased complication rates. These metabolic alterations can be improved by insulin administered exogenously. Since a wide range of insulin dosages have been used, this randomized, placebo-controlled, investigator-blinded, clinical study tests the hypothesis that a low-dose insulin regimen improves hyperglycemia and protein catabolism in critically ill medical patients. The day after their admission to a medical intensive care unit, forty consecutive, critically ill medical patients were randomized for receiving either a low-dose insulin regimen (i.e. 1 IU/h) (treatment group, n = 20) or placebo (control group, n = 20) continuously over 24 hours. The primary endpoint was the efficacy of the low-dose insulin regimen to decrease serum glucose concentrations; the secondary endpoint was its influence on protein catabolism. Serum glucose concentrations and protein catabolism, which was assessed by the urea nitrogen appearance rate, were determined at baseline and at 8 and 24 hours thereafter. Serum insulin concentrations were measured at baseline and after 24 hours. After 24 hours the low-dose insulin regimen increased serum insulin concentrations compared with baseline (16.8+/-13.3 microU/ml and 11.5+/-16.9 microU/ml, respectively; p
ISSN:0043-5325
1613-7671
DOI:10.1007/s00508-004-0236-4