Hyperglycemia during acute coronary syndrome: A nurse-managed insulin infusion protocol for stricter and safer control

Fausto Avanzini, Giuseppe Marelli, Walter Donzelli, Loredana Sorbara, Enzo Palazzo, Laura Bellato, Elena Lucia Colombo, Maria Carla Roncaglioni, Emma Riva, Mario De Martini

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Diabetic patients with acute coronary syndromes (ACS) might benefit from tight glycemic control by means of insulin infusion. Nurse-implemented insulin infusion protocols (IIP) are available but none validated in patients with ACS admitted to a coronary care unit (CCU). Aims: To assess feasibility, effectiveness and safety of a new nurse-managed IIP (Desio Diabetes Diagram, DDD) for intensive glucose control in patients with suspected ACS and known diabetes or blood glucose (BG) > 200 mg/dL. Methods and results: To reach and maintain a target BG level of 100-139 mg/dL we adopted a nomogram based on the percent changes in the insulin infusion rate according to the current BG value and the percent change from previous BG level. Ninety-one consecutive patients (53 men, mean age 69.7 ± 11.2 years) were treated with DDD IIP. Baseline BG was 202.2 ± 86.8 mg/dL. The median time to achieve the target was 3 h (Q1-Q3 2-5 h). Afterwards target BG levels were maintained for 70.4 ± 15.9% of the time. During 5004 h of insulin infusion BG never fell below 40 mg/dL. Conclusions: The nurse-managed DDD IIP was easily implemented in our CCU and permitted strict and safe glycemic control in hyperglycemic patients with ACS.

Original languageEnglish
Pages (from-to)182-189
Number of pages8
JournalEuropean Journal of Cardiovascular Nursing
Volume8
Issue number3
DOIs
Publication statusPublished - Aug 2009

Keywords

  • Acute coronary syndrome
  • Diabetes
  • Glucose variability
  • Hypoglycemia
  • Insulin infusion

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialised Nursing
  • Medical–Surgical

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