Dr. Om J Lakhani talks about glycemic management (hyperglycemia and hypoglycemia) management in ICU patients

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00:27 Target blood sugar range for critically ill patients is 140180 mg/dL in adults.
01:44 Infection or inflammation can trigger hypoglycemia in diabetic patients, creating a negative cycle of glucotoxicity and perpetuating infection.
03:35 ⚠ Counterregulatory hormones like vasopressors and glucocorticoids used in critical illness contribute to hyperglycemia, necessitating cautious management.
04:33 ⚖ Both hyperglycemia and hypoglycemia correlate with poor clinical outcomes in critically ill patients.
05:13 Elevated blood sugar levels (More than 200 mg/dL) in trauma patients are associated with poor outcomes.
08:44 Current guidelines recommend maintaining blood sugar levels between 140200 mg/dL in ICU patients, balancing glycemic control with risk of hypoglycemia.
12:27 Four pillars of managing diabetes in ICU: glycemic control, infection management, addressing other clinical conditions, and discontinuing medications affecting blood sugar.
16:36 IV insulin infusion is the cornerstone of therapy for glycemic control in ICU, targeting blood sugar between 140200 mg/dL.
17:30 ❌ Sliding scale insulin should be avoided in ICU settings due to its reactive nature and potential harm, favoring proactive management strategies.
21:25 IV insulin infusion is a cornerstone in ICU hyperglycemia management, with various protocol options available.
22:22 Yale protocol, a standard approach, involves mixing regular insulin with saline and adjusting infusion rates based on current blood sugar levels.
23:32 ⚠ Avoid the anchoring effect; even blood sugars within normal ranges might seem low in critical care settings.
25:12 Yale protocol recommends hourly glucose checks initially, transitioning to less frequent monitoring as stability is achieved.
28:39 Consider simultaneous subcutaneous insulin in addition to IV insulin for better glycemic control and reducing sudden glucose fluctuations.
34:16 Hypoglycemia management involves recognizing different levels and administering glucose orally or intravenously based on severity, while addressing underlying causes like insulin deficiency or druginduced effects.


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