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Another bad study - Intensive Control in ICU

Doris' Blog
By: dorisjdickson

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Posted: Mar 30, 2009 8:47
  • Another bad study - Intensive Control in ICU

    This article on Intensive Control in the ICU was in Saturday's issue of Endocrine Today discusses yet another very bad study.  "In my opinion" (and I hate that phrase) it rivals the ACCORD study in the stupidity department.

    Those of us who target tight control did not do it overnight.  That's not safe and we know that.  For example, when I changed my targets from the "recommended" 110-140 and A1Cs of 6's to a target of 85 I did it in stages.  A body adapts to bad or good blood sugar levels; it can feel the difference and it WILL talk back if you do anything drastic.  So, even at moderately high initial targets I reduced my target in two stages - first I went to 100; then to 85.  That way I didn't constantly feel low - ya know, heart racing, hungry, shaky, etc., etc.  Nor did my eyes, nerve endings or stomach wreak havoc.  Instead, I noticed very rapid improvement safely and painlessly.

    So, why did hospitals or those participating in this study think it would possibly be healthy and safe to drastically reduce the target of critically ill hospital patients?  They are already at high risk - for everything!  You can not take someone who has had continued high blood sugar and lower the targets while they are 1) very sick 2) lying in a hospital bed 3) not doing anything normally.  They are lying on their backsides in a bed.  They aren't eating normally. They are likely hooked up to a glucose/insulin IV!  They are stressed beyond belief.

    What are they thinking?

    On top of making these people worse, they (yet again) make tight control appear unsafe when it is not.  It is the method that is unsafe.  It's not that difficult to do it safely.  And with all the education and experience these caregivers have, they really could learn to teach reduced blood sugar targets safely!  Patients who are lying flat on their backs in the hospital under anything but normal conditions ARE NOT the people with whom to play russian roulette.

    The Joslin has two protocols for hospital patients - 80-110 and 101-150.  I actually have a two-part article awaiting medical review on the subject.  I have to say.  I did NOT address this particular group of patients.  My article is intended as a tool for healthy patients requiring procedures or healthy patients admitted in emergency situations.  I look forward to its release.

    Doris J. Dickson

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