Daily BS #3 10/11/21
ICU and more Normal Blood Sugar
Topic: Study on ICU outcomes with normal blood sugars
Just one study today but it’s an excellent one!
Yesterday was Canadian Thanksgiving and my ‘reading time’ was shorter than normal.
Intensive Care Outcomes & Blood Sugar
The study, “Intensive Insulin Therapy in Critically Ill Patients“ is very interesting!
This study compares normal blood sugars to very elevated blood sugars.
In many studies the researchers compare ‘diabetic normal blood sugars’, 140 mg/dl (or 7.4 mmol/l) with even WORSE blood sugars.
This study is different.
In the ICU, one group of people were given insulin to maintain blood sugars in the 80 to 110 mg/dl range or (4.2 to 5.8 mmol/l). They call this the ‘intensive insulin group’.
In another group, insulin was used to maintain blood sugars in the 180 to 200 mg/dl range (or 9.5 to 10.6 mmol/l). This is the ‘conventional treatment group’. I could rant about this point… but I won’t. 180+ mg/dl is harmfully high blood sugars and should NOT be ‘conventional’ … it is unethical and immoral.
But let’s move along…
Results of the study? Mortality or death in the hospital was reduced from 8.0% with the conventional treatment to 4.6% in the intensive insulin group!
From the study:
Intensive insulin therapy also reduced overall in-hospital mortality by 34 percent, bloodstream infections by 46 percent, acute renal failure requiring dialysis or hemofiltration by 41 percent, the median number of red-cell transfusions by 50 percent, and critical-illness polyneuropathy by 44 percent, and patients receiving intensive therapy were less likely to require prolonged mechanical ventilation and intensive care.
Isn’t this fantastic news? Lives can be saved! Money can be saved!
With news like this I’m sure the Medical Industry including the American Diabetes Association will adjust their in-hospital protocols… right?
Sadly … no. This study was published in 2001 … hospitals and Intensive Care Units, from my experience do not target normal blood sugar goals for hospital or ICU patients.
Intensive insulin therapy to maintain blood glucose at or below 110 mg per deciliter reduces morbidity and mortality among critically ill patients in the surgical intensive care unit.
This study shows that maintaining normal blood sugar is without question more beneficial than maintaining elevated blood sugars!
As we’ll see below the results could have been EVEN better …
Additional Points of Interest
When reading diabetes or nutritional studies one of the big questions you need to ask is … “so what did the subjects eat?”.
On admission, all patients were fed continuously with intravenous glucose (200 to 300 g per 24 hours). The next day, total parenteral, combined parenteral and enteral, or total enteral feeding was instituted according to a standardized schedule, with 20 to 30 nonprotein kilocalories per kilogram of body weight per 24 hours and a balanced composition (including 0.13 to 0.26 g of nitrogen per kilogram per 24 hours and 20 to 40 percent of nonprotein calories in the form of lipids).23
Damn… using the info above, I’d get about 210 g of glucose per day!
Ugh! No thanks. I have not only survived but thrived for years… on less than 20g of carbs per day, most of that is fiber.
Hypoglycemia (defined as a blood glucose level of 40 mg per deciliter [2.2 mmol per liter] or less) occurred in 39 patients in the intensive-treatment group and in 6 patients in the conventional-treatment group. In two patients who received intensive insulin therapy, hypoglycemia was associated with sweating and agitation, but there were no instances of hemodynamic deterioration or convulsions.
39 patients experienced hypoglycemia or ‘low’ blood sugar is not good, but 39 people out of 1,584 test patients is only 2.4%.
Also, I’d suggest not pumping the patients with 200+ grams of sugar (glucose)… that might make it easier to control blood sugars without dipping into hypoglycemic ranges. Just an idea… to ponder.
‘Carb up and shoot up’ (with insulin) is a failed protocol promoted by the Medical Industry’s … and it needs to end.
Lastly, I’m not sure what they consider ‘hypoglycemia’, it may be in the study but I was running out of time.
Just know, I’ve been fine with my blood sugars in the 60 to 70 mg/dl range (3.1 to 3.7 mmol/1 ).
In conclusion, the use of exogenous insulin to maintain blood glucose at a level no higher than 110 mg per deciliter reduced morbidity and mortality among critically ill patients in the surgical intensive care unit, regardless of whether they had a history of diabetes.
And I contend the results would have been EVEN better had they not pumped 200 g of glucose, which required higher levels of insulin.
Thanks for reading the “Daily BS”!
My blood sugar goals are to maintain truly normal blood sugars … not ‘diabetic normal’ blood sugars.
Elevated blood sugars are not healthy, we know this.
This is just another study showing the advantages of TRULY normal blood sugars. Here is a post I wrote on my targets, “My Blood Sugar Targets and Why“.
Until next time… have fun in the sun!