Intravenous insulin for the management of non-emergent hyperglycemia in the emergency department.

Abstract

There is currently no consensus regarding the necessity of emergency department (ED) glucose reduction to manage hyperglycemia in patients presenting without a hyperglycemic emergency. Known consequences of intravenous (IV) insulin administration include hypoglycemia, hypokalemia, and increased ED length of stay. The primary objective of this study was to assess the impact of IV regular insulin on glucose reduction and ED length of stay in patients presenting to the ED with non-emergent hyperglycemia. Secondary objectives included the characterization of potential adverse events. This was a retrospective, observational study of patients ≥18years who received IV regular insulin and were discharged from the ED at a large academic Trauma Center. Univariate and multivariable regression analyses were utilized to determine if an association existed between IV insulin administration and blood glucose as well as ED length of stay. A total of 405 patients were included in the analysis. An insulin dose >5units was associated with a greater reduction in blood glucose (difference=37.4mg/dL; p<.001) but no difference in ED length of stay relative to ≤5units. Furthermore, 7.9% of patients developed hypokalemia and 0.4% developed hypoglycemia. The use of >5units of IV regular insulin for the management of isolated hyperglycemia in the ED was associated with a modest reduction in blood glucose and no difference in ED length of stay compared with those that received ≤5units. However, use of IV insulin for this purpose resulted in a 7.9% occurrence of hypokalemia.