A Bittersweet Balance: Adjunct Therapy for Hyperglycemia in Critically Ill Patients

Stress-induced hyperglycemia in critically ill patients negatively affects their recovery. Providers have struggled to balance the treatment of hyperglycemia with aggressive insulin therapy with the risk of hypoglycemia as an adverse effect. Both immobilization and continuous enteral nutrition are common in a critical care setting and have implications as contributors for further hyperglycemia due to decreased peripheral glucose uptake and worsening insulin resistance. We propose to determine if an aggressive early mobilization protocol and nutrition protocol in the form of bolus feeds will decrease the amount of insulin units needed to treat hyperglycemia in critically ill patients. To do so, patients over 18 years old will be randomized to one of four intervention groups receiving either standard of care and/or intervention nutrition and mobilization protocol, in a medical intensive care unit at two campuses of an academic institution. The results could change the management of hyperglycemia in critically ill patients, limiting the amount of insulin units required and lowering the risks of hypoglycemia