Patients will be randomized into 2 equal groups; Group 1 (SCU group) will follow the SCU
protocol of Intravenous Insulin Infusion in diabetic critically ill patients Group 2 (NHS
group) will follow the NHS protocol of Intravenous Insulin Infusion in critically ill
diabetic patients in UK.
Randomization will be done using a web randomizer and the randomization sequence will be
concealed in numbered opaque envelopes that will be opened after patient enrollment to
define his or her group assignment.
In both groups, control of blood glucose will be achieved with the use of an intravenous
infusion of regular insulin in saline. Insulin will be administered, reduced, or
discontinued according to the protocol in the different groups.
Two nurses must check and prepare the variable rate intravenous insulin infusion (VRIII)
and every time the rate of infusion is changed. Insulin must be drawn up using an insulin
syringe to draw up 50 units of prescribed Human Act rapid insulin and add to 49.5 ml of
0.9% sodium chloride in a 50 ml syringe. Mix thoroughly; this will provide a
concentration of 1 unit / 1 ml.
VRIII will be stopped when RBS <80mg/dl and repeat the measure of RBS after one hour.
Laboratory investigations of routine blood tests will be requested on admission and at
least once daily and in case of abnormal potassium level will be measured every 6 hours.
Regarding Serum K:
If K is 3.5-5.5 mmol/l- This is the target: total K+ given should be 1.5 mmol/kg/day If K
is >5.5 mmol/l - no K is to be added to the infusion fluid this day. If K is <3.5mmol/l -
K+ given should be 2.0 mmol/kg/day. K+ replacement will be initiated if there are ECG
changes of hypokalemia. If K is <2.5mmol/l - bolus K+ replacement 1 mEq/kg will be
infused over 3 hours and serum K+ level rechecked 2 hours after the end of infusion. If
recheck serum K+ level < 2.5mmol/l bolus K+ replacement will be infused again over 3
hours. If recheck serum K+ level >3mmol/l K+ maintenance will be infused 2.0 mmol/kg/day.
Data collection :
At baseline, demographic and clinical characteristics, including the Acute Physiology and
Chronic Health Evaluation II (APACHE II) score and the diagnostic criteria for severe
sepsis will be collected.
Medical history :
Medical chronic disorders and the used treatment for them, such as hypertension,
diabetes, liver or renal diseases .
Any known allergies to the drugs to be used . laboratory investigations:
a) Daily Routine Blood test (CBC, ABG, Electrolytes). b) Prothrombin time (PT), partial
tissue thromboplastin time (PTT) and International randomized ratio (INR), Liver function
tests and Kidney function tests every 3 days.
c) HBA1c on admission.
Follow up:
Nutrition: NPO, Enteral or parental.
Mechanical Ventilation days.
Complications: DKA, Hyperglycemia or Hypoglycemia.
ICU Discharge Date.
Hospital Discharge Date.
d) Outcome: Discharge or Death.