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Van den Berghe et al

Intensive insulin therapy

  • tight control of blood sugar in the range of 4.4-6.1 mmol/l associated with improved outcome (42% decrease in ICU mortality). Not clear whether this beneficial effect is due to tight control per se or is the effect of insulin as the patients in the study received a continuous infusion of 10% glucose. There is evidence to suggest that the beneficial effect results from non-glucose related effects of insulin:
    • anti-inflammatory effect
    • prevention of immune paralysis

Ischaemic heart disease

  • some evidence to suggest that glucose-insulin-potassium (GIK) infusions may improve outcome following acute myocardial infarction and following coronary artery bypass surgery. (Also many of the patients in the study showing tight glucose control improves outcome were post-cardiac sur
  • keep plasma glucose <6 mmol/l. Continue for 24-48h post reperfusion

Further reading

Davey G and McKeigue P. Insulin infusion in diabetic patients with acute myocardial infarction. Br Med J, 1996; 313:639 (free)

Diaz R, Paolasso EA, Piegas LS et al. Metabolic modulation of acute myocardial infarction. The ECLA (Estudios Cardiologicos Latinoamerica) Collaborative Group. Circulation. 1998;98:2227-34. (free)

Lazar HL The Insulin Cardioplegia Trial J. Thorac. Cardiovasc. Surg., 2002; 123(5):842-4

Van den Berghe G et al. Intensive insulin therapy in critically ill patients. N Engl J Med, 2001; 345:1359-67 (free but requires registration)


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