Tight control of BG in the ICU may be dangerous: the NICE-SUGAR study

Dr. Bill Quick Health Professional Physician and Medical Director of DiabetesMonitor.com Dr. Bill Quick and his wife Steph are the authors of one of the ... Send Message Subscribe: Dr. Bill Quick

Wednesday, March 25, 2009
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Another cute acronym, NICE-SUGAR, is the acronym for "Normoglycemia in Intensive Care Evaluation-Survival Using Glucose Algorithm Regulation," a study that was just published in the New England Journal of Medicine. The authors looked at intensive versus conventional glucose control in critically ill...

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Anonymous
Thursday, March 26, 2009 at 12:05 AM

Maybe if they avoided pumping people full of sugar it would help

Sliding Scale Still Used in Hospitals
Jenny Ruhl
Thursday, March 26, 2009 at 09:17 AM

When I was in the hospital the nurse wanted to dose me using "sliding scale" with no understanding of my insulin/carb ratio.

This is an outdated mode of dosing based on premeal blood sugar with no relationship to carbs consumed. It is impossible to get tight control with sliding scale dosing.

If doctors and nurses understood insulin dosing--which they don't outside of the endo community--we'd have seen a different result.

Tragically I'm already hearing from patients being told by their physicians that A1cs under 7% are "dangerous." These are type 2s controlling with diet.

re: Sliding Scale Still Used in Hospitals
Dr. Bill Quick
Thursday, March 26, 2009 at 09:38 AM

I really got to write a SharePost on why I think "Sliding Scales Suck"

re: re: Sliding Scale Still Used in Hospitals
denise
Thursday, March 26, 2009 at 10:04 AM

PLEASE do...for those of us type 1's that are very insulin sensitive..it not only sucks its downright dangerous! A normal sliding scale spells serious low danger for me..my second hospitalization my endo had my pump trainer come to the hospital to do my pump training (timing is everything--I ended up in a emergency surgery situation after my pump had been approved and ordered) because the staff seemed incapable of following his orders.

Even though I ended up in the hospital for a month, I am sure it would have been longer had I not gotten on my pump.

It also provided a very unique educational opportunity for the staff--everyone (including my surgeon) was very intersted in the pump--how it workd and was amazed and the immediate improvement and stabalizatiojn of my bg!

this bed is too hard, this one is too soft, this one...
frankenduf
Thursday, March 26, 2009 at 05:06 PM

i thought that the progression of the 2nd wave GLC studies were towards a 2 tier system- that is, the VandenBerg landmark established the deleterious effects of high GLC, but now the new studies are honing in on optimal GLC, which differs for DM and nonDM- for nonDM, euglycemia is best, but for DM, sustained control @140 is safer- i guess a common sense explanation is that DM bodies are calibrated to hyperglycemia, so euglycemia may have deleterious effects on organ GLC metabolism- besides, my hospital's endocrine dept. would have a cow if we rolled back insulin pump protocols from the ICUs :)- thanx for the post- we really are living through the age of determining, via trial-and-error, the best way to treat acute hyperglycemia