Skip to main content

Table 2 Glycemic control, ketonemia, ketonuria and acid–base status of diabetic patients with and without permissive hyperglycemia

From: Prevalence of ketosis, ketonuria, and ketoacidosis during liberal glycemic control in critically ill patients with diabetes: an observational study

Variable All patients Peak BGL Peak BGL P value
≥10 mmol/l <10 mmol/l
Number of patients, n (%) 60 (100) 46 (77) 14 (23)  
No. of blood glucose measurements, n (%) 280 229 51  
No. of blood glucose measurements per patient 4 (3, 7) 4 (3, 7) 3 (2, 5) 0.19
Peak glucose level, mmol/l 12.0 (10.0, 15.0) 14 (12, 17) 8.2 (7.4, 9.5) <0.001
Mean glucose level, mmol/l 10.0 (8.3, 13.0) 12 (9.5, 13) 7.1 (6.6, 8.3) <0.001
Min glucose level, mmol/l 8.0 (6.2, 9.4) 8.8 (7, 9.9) 6.2 (5.7, 7.5) 0.007
No. of blood ketone measurements, n (%) 277 228 49  
No. of blood ketone measurements per patient 4 (3, 7) 4 (3, 7) 3 (2, 4) 0.11
Time between ICU admission until first measurement, hours 8.3 (1.6, 12) 8.9 (1.7, 13) 3.2 (1.5, 11) 0.02
Patients receiving insulin, n (%) 27 (45) 27 (59) 0  
Intravenous insulin rate, units/h 2 (1, 2) 2 (1, 2) 0  
Patients receiving nutrition, n (%) 29 (48) 27 (59) 2 (14)  
 Enteral nutrition, n (%) 28 (47) 26 (57) 2 (14)  
 Total parenteral nutrition, n (%) 2 (3.3) 2 (4.3) 0  
Patients receiving catecholamine infusion, n (%) 30 (50) 27 (46) 3 (21) 0.03
 Noradrenaline, n (%) 29 (48) 26 (57) 3 (21) 0.03
 Maximum noradrenaline rate, μg/min 5.0 (2.0, 16) 7.5 (2.0, 16) 2.0 (1.0, 4.0) 0.11
 Adrenaline, n (%) 7 (12) 7 (15) 0  
 Maximum adrenaline rate, μg/min 3.0 (2.0, 4.0) 3.0 (2.0, 4.0) NA  
Ketosis episodes >0.6 mmol/l, n (%) 79 (28.6) 63 (28) 16 (33) 0.43
Peak blood ketones, mmol/l 0.8 (0.3, 1.9) 0.85 (0.2, 1.9) 0.65 (0.3, 1.0) 0.32
Worst ketosis, n (%)     0.52
 No ketosis (<0.6 mmol/l) 22 (36.7) 16 (35) 6 (42)  
 Mild (0.6–1.5 mmol/l) 20 (33.3) 15 (33) 5 (36)  
 Moderate (1.6–3.0 mmol/l) 11 (18.3) 8 (17) 3 (21)  
 Marked (>3.0 mmol/l) 7 (11.7) 7 (15) 0  
Number of urine ketone measurements 261 215 46  
Worst ketonuria, n (%)     0.51
 No ketonuria 40 (66.7) 31 (67) 9 (64)  
 Mild (1+) 13 (21.7) 10 (22) 3 (21)  
 Moderate (2+) 6 (10) 5 (11) 1 (7)  
 Marked (3+) 1 (1.7) 0 1 (7)  
Patients with alkalosisa, n (%) 25 (42) 20 (43) 5 (36) 0.76
Blood gas analysis, worst value during study period
 pH 7.4 (7.3, 7.4) 7.3 (7.3, 7.4) 7.4 (7.3, 7.4) 0.32
 Lactate, mmol/l 2.2 (1.6, 3.1) 2.3 (1.7, 3.4) 2 (1.4, 2.3) 0.15
 Bicarbonate, mmol/l 22 (20, 24) 22 (19, 24) 25 (23, 26) 0.002
 Chloride, mmol/l 108 (104, 111) 108 (104, 111) 105 (102, 108) 0.10
 Sodium, mmol/l 136 (132, 138) 136 (132, 138) 136 (132, 136) 0.73
 Albumin, g/l 26 (22, 30) 26 (21, 29) 29 (23, 30) 0.75
 Base excess (BE), mmol/l −2.8 (−5, 0) −3 (−5, −1) 0.35 (−4, 1) 0.006
ADA ketoacidosis, n (%) 2/60 (3.3) 1/46 (2.2) 1/14 (7.1) 1.00
JBDS ketoacidosis, n (%) 0/60 (0)    
  1. Values are median (IQR) or n (%)
  2. BGL blood glucose level, ICU intensive care unit, ADA American Diabetes Association, JBDS Joint British Diabetes Society
  3. apH >7.45