Controlling hyperglycemia in the hospital setting

Roma Gianchandani, M.D.

Patients hospitalized due to a critical illness or following major surgery are at an increased risk of developing hyperglycemia as a result of stress-induced insulin resistance. This is the case for both people with and without diabetes.

The major cause of hyperglycemia is the release of counter-regulatory stress hormones (namely cortisol, growth hormone, catecholamines, and glucagon) and local tissue cytokines. Additional factors common to a hospital setting, such as excessive nutritional support, sepsis, hypothermia, hypoxemia, uremia and cirrhosis further  reduce insulin production and can worsen insulin resistance.

Although hyperglycemia in critically ill patients is a serious risk factor for inpatient morbidity and mortality, it is also a correctable one. Data support the use of carefully monitored insulin infusion protocols to correct hyperglycemia, especially in the setting of cardiothoracic surgery, heart failure and critical care.

U-M’s Hospital Intensive Insulin Program (HIIP) is an inpatient program designed to manage diabetic/hyperglycemic inpatients. The program is run by Roma Gianchandani, M.D. HIIP currently operates on the thoracic surgery wings of the University of Michigan Hospital, where it has demonstrated significant reduction in length of stay. Given HIIP’s potential to reduce post-discharge emergency room visits and hospital readmissions, U-M is currently exploring expansion of the program to additional inpatient surgical services.

To connect with Dr. Gianchandani and learn more about managing inpatient hyperglycemia, call M-Line at 800-962-3555.