Care of Diabetes in ICU and Perisurgery

Critically ill patients and patients undergoing major surgery usually develop stress hyperglycaemia, which is associated with an increased morbidity and mortality risk. Randomized controlled trials interfering with elevated blood glucose during intensive care and the perioperative period have yielded mixed results, however. The optimal blood glucose target may depend on the context. Tight glucose control was shown to be effective and safe when performed with accurate glucose measurement tools and a reliable insulin infusion protocol in patients receiving early parenteral nutrition. Whether tight glucose control is beneficial in the absence of early parenteral nutrition, remains to be studied. In any case, hypoglycaemia and severe hyperglycaemia should be avoided. In patients with poorly controlled diabetes, the ideal blood glucose target may be higher than in non-diabetics.