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Subcutaneous Insulin in the Critically Ill
- Although intensive insulin therapy in the critically ill remains controversial and a matter of much debate, hyperglycemia is common in the critically ill ED patient
- Hyperglycemia is associated with worse outcomes in this patient population
- When treating hyperglycemia in the critically ill ED patient, use caution with subcutaneous insulin
- Absoprtion of insulin administered subcutaneously is slow, erratic, and highly variable often due to poor perfusion, hypotension, and/or vasopressor therapy
- In these patients, IV insulin is a better route of administration and leads to more reliable control of hyperglycemia
- Recall that the onset of action of insulin given IV is 10 - 30 minutes, with a duration of action of about 1 hour
References
Shipman K, Frankel HL. Do not use subcutaneous insulin in the intensive care unit population. In: Marcucci L, et al. Avoiding Common ICU Errors. Lippincott Williams & Wilkins; Phildelphia, PA, 2007