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Glucose control and the incidence of severe hypoglycaemia in a burns population following the introduction of intensive insulin therapy


Hyperglycaemia is often associated with the hypermetabolic response to burn injury. It is perceived that glycaemic control can be difficult in a burns population. The aims of this study are to define the level of glycaemic control and the incidence of severe hypoglycaemia since the introduction of a nurse-led intensive insulin programme in a tertiary referral burns intensive therapy unit (BITU).


A retrospective analysis of blood glucose levels following the introduction of a tight glycaemic target range (4.4–6.1 mmol/l) in November 2003. The study period was 42 months. All patients were admissions to the BITU. Insulin therapy was initiated once glucose levels were outside the defined range and were adjusted by nursing staff according to a regularly revised glucose/insulin sliding scale. Glucose levels were obtained by whole blood analysis using an onsite blood gas analyser (Chiron Diagnostics, Novartis, USA) subjected to daily calibration.


In total, 24,602 blood glucose measurements were recorded within the study period. For 146 adult admissions (mean age = 47.7 years, mean% burn = 42.25%), there were 19,723 measurements. Median blood glucose = 7.1 mmol/l (IQR ± 2.2). Of these measurements, 22.6% were within the target range. Thirty per cent were >8.0 mmol/l. Incidence of severe hypoglycaemia was 0.21%. For 85 paediatric (age ≤ 16 years) admissions (mean age = 6.9 years, mean% burn = 43.5%), there were 4,879 recorded blood glucose measurements. Median = 6.8 mmol/l (IQR ± 2.2); 29.1% of measurements were within the target range, and 23.5% were >8.0 mmol/l. The incidence of severe hypoglycaemia was 0.22% (see Figure 1 and 2).

Figure 1
figure 1

Glucose distribution.

Figure 2
figure 2

Pediatric Blood Glucose Distribution.


The defined management strategy did not achieve tight glycaemic control; however, the majority of measurements were less than 8.0 mmol/l, as recommended by the Surviving Sepsis Campaign [1]. Paediatric patients had more results within the defined range compared with adult patients. The rate of severe hypoglycaemia was only 0.2%. Given the potential morbidity of severe hypoglycaemia and the uncertain benefit of intensive insulin therapy, this approach has produced an acceptable level of glycaemic control.


  1. Dellinger RP, et al.: Surviving Sepsis Campaign guidelines for management of severe sepsis and septic shock. Crit Care Med 2004, 32: 858-873. 10.1097/01.CCM.0000117317.18092.E4

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Arawwawala, D., Kooner, T. & Dziewulski, P. Glucose control and the incidence of severe hypoglycaemia in a burns population following the introduction of intensive insulin therapy. Crit Care 12 (Suppl 2), P158 (2008).

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