Insulin and glycemia control in critically ill patients

Intensive insulin therapy for glycemic control may be beneficial to critically ill patients, even if many studies have reported an increased risk of severe hypoglycemia. The objective of effective therapy is to avoid severe hypoglycemia and the adverse outcomes associated with hyperglycemia. Various protocols to guide intensive insulin therapy have been described but it is difficult to establish which is the best. All protocols address the problem by taking into account only the glucose plasma concentration, with no mention of insulin resistance or glucose supply. We analyze the key issues for a safe protocol of intensive insulin therapy with a glycemia target not exceeding 150-140 mg/dL.