Feasibility and safety of multiple daily insulin injections in general medicine wards

Abstract

Aim Intravenous insulin improves clinical outcome in patients hospitalized in intensive care units. Whether glucose control with multiple daily subcutaneous insulin injections (MDI) is beneficial in patients hospitalized in general medical wards is unknown. We tested the feasibility, safety and efficacy of glucose control with MDI in diabetic patients hospitalized in a general medicine ward. Methods Eighty-eight adults with diabetes mellitus were studied in an internal medicine department. All patients were treated with subcutaneous pre-meal insulin analogue and Glargin insulin. A conservative and an intensified protocol was tested. Results Mean daily glucose levels decreased in the conservatively treated patients from 275 ± 71 mg/dl at day 1 to 197.0 ± 60 mg/dl at day 4 of hospitalization p = 0.0001 and in the intensified protocol to 191 ± 38 mg/dl already on day 1 remaining stable throughout the hospitalization. A mean daily glucose < 180 mg% was reached by day 2 in 48% of patients in the intensified and in 32% in the conservative groups. Only one serious event of hypoglycemia was noted in the intensified group. Conclusion Intensive insulin treatment with MDI is feasible, safe and efficacious in general medicine wards.