48-Outcomes and Adverse Effects of Extreme Insulin Resistance in ICU Patients
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Pharmacology, Endocrine, 2021
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The Society of Critical Care Medicine's Critical Care Congress features internationally renowned faculty and content sessions highlighting the most up-to-date, evidence-based developments in critical care medicine. This is a presentation from the 2021 Critical Care Congress held virtually from January 31-February 12, 2021.

Arianna Vidger


Introduction/Hypothesis: Extreme insulin resistance is a phenomenon reported in some ICU patients. Clinical data to guide management of these patients are lacking. The goal of this study was to describe the characteristics, hospital course, and outcomes of critically ill adult patients with extreme insulin resistance.

Methods: Adult ICU patients on IV insulin infusions between January 2016 and December 2019 were eligible for inclusion in this retrospective observational cohort study. Patients on insulin infusion <12 hours, receiving insulin infusion for suspected overdose or acute hyperglycemic crisis, and those with incomplete medical records were excluded. Extreme insulin resistance was defined as being on an insulin infusion with at least one charted rate ≥35 units/hour. Patients with extreme insulin resistance were included in a 1:3 ratio to patients without extreme insulin resistance. The primary endpoints were rate of hypoglycemia and time to glucose control.

Results: One hundred twenty-eight patients were included, 32 had extreme insulin resistance. Baseline characteristics varied between groups. Patients in the extreme group were more likely to have type 2 diabetes (78% v. 43%,p< 0.05), be on insulin prior to admission (65% v. 33%,p< 0.01), have a higher hemoglobin A1c (median 8.1 v. 6.9,p=0.019), be admitted for a medical reason (63% v. 20%,p<0.001), and receive steroids during admission (75% v. 39%,p<0.001). Median admission SOFA scores were similar between groups (7.5 v. 7,p=0.433). Any hypoglycemia (63% v. 34%,p=0.005) and moderate hypoglycemia (50-70 mg/dL) (53% v. 26%,p<0.01) were more common in the extreme group. Severe hypoglycemia (<50 mg/dL) was similar between groups (9% v. 8%,p =0.86). The extreme group had a longer time to glucose control (median 19.8 v. 5.7hr,p<0.001), received higher maximum insulin infusion rates (median 39.8 v. 7.6 units/hr,p<0.001), had a longer ICU length of stay (median 9.6 d v. 5.1d,p=0.027), and had a higher mortality rate (34% v. 15%,p=0.014).

Conclusions: ICU patients with extreme insulin resistance had higher rates of hypoglycemia and took longer to achieve glucose targets compared to those without extreme insulin resistance. An individualized approach may be required to avoid hypoglycemia in this patient population.


Meta Tag
Content Type Presentation
Knowledge Area Pharmacology
Knowledge Area Endocrine
Knowledge Level Advanced
Membership Level Select
Tag Diabetes
Tag Insulin
Year 2021
critically ill patients
extreme insulin resistance
glucose control
ICU stays


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