Figure 4

Temporal plot comparing CGM readings and BG values. With software provided with the CGM, CGM values and BG values were plotted over time. CGM values (gray dots that at times morph into a line) are acquired approximately every five minutes, and BG values (black squares) sporadically per regular care. We define persistent BG >140 mg/dL (7.7 mmol/L) as critical illness hyperglycemia, and have traditionally managed those more than six months old with insulin infusions to a target BG of 80 to 140 mg/dL (4.4 to 7.7 mmol/L) (black dashed lines). The top plot (A) represents data from a 13 year-old male with traumatic brain injury requiring mechanical ventilation and norepinephrine to maintain his cerebral perfusion pressure. The arrows indicate when insulin was started and stopped per our protocol to manage his hyperglycemia. The data in B is from a five-month-old male with Trisomy 21, RSV, pulmonary hypertension, and refractory hypoxemia requiring high frequency oscillatory ventilation, inhaled nitric oxide, milrinone, and an epinephrine infusion. At the time of this study, this patient was below our typical age threshold for protocolized hyperglycemic management, and he was not treated with insulin.