Weight-Based, Insulin Dose–Related Hypoglycemia in Hospitalized Patients With Diabetes  

Oleh:

Rubin, Daniel J. ; Rybin, Denis ; Doros, Gheorghe ; McDonnell, Marie E.

Jenis: Article from Journal - ilmiah internasional
Dalam koleksi: Diabetes Care vol. 34 no. 08 (Aug. 2011), page 1723-1728 .
Topik: Hypoglycemia; Insulin

Ketersediaan

Perpustakaan FK Nomor Panggil: D05.K Non-tandon: 1 (dapat dipinjam: 0) Tandon: tidak ada

Lihat Detail Induk

Isi artikel

OBJECTIVE To determine the association of weight-based insulin dose with hypoglycemia in noncritically ill inpatients with diabetes. RESEARCH DESIGN AND METHODS We performed a retrospective, case-control study of 1,990 diabetic patients admitted to hospital wards. Patients with glucose levels <70 mg/dL (case subjects) were matched one to one with nonhypoglycemic control subjects on the basis of the hospital day of hypoglycemia, age, sex, and BMI. RESULTS Relative to 24-h insulin doses <0.2 units/kg, the unadjusted odds of hypoglycemia increased with increasing insulin dose. Adjusted for insulin type, sliding-scale insulin use, and albumin, creatinine, and hematocrit levels, the higher odds of hypoglycemia with increasing insulin doses remained (0.6–0.8 units/kg: odds ratio 2.10 [95% CI 1.08–4.09], P = 0.028; >0.8 units/kg: 2.95 [1.54–5.65], P = 0.001). The adjusted odds of hypoglycemia were not greater in patients who received 0.2–0.4 units/kg (1.08 [0.64–1.81], P = 0.78) or 0.4–0.6 units/kg (1.60 [0.90–2.86], P = 0.11). Although the relationship between insulin dose and hypoglycemia did not vary by insulin type, patients who received NPH trended toward greater odds of hypoglycemia compared with those given other insulins. CONCLUSIONS Higher weight-based insulin doses are associated with greater odds of hypoglycemia independent of insulin type. However, 0.6 units/kg seems to be a threshold below which the odds of hypoglycemia are relatively low. These findings may help clinicians use insulin more safely. Footnotes This article contains Supplementary Data online at http://care.diabetesjournals.org/lookup/suppl/doi:10.2337/dc10-2434/-/DC1. Received December 26, 2010. Accepted May 24, 2011. © 2011 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered.

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