Monitoring Blood Glucose in Critically Ill Patients

Considerations for Monitoring Method

In critically ill patients who require invasive vascular monitoring, arterial blood samples are recommended for glucose measurement instead of capillary blood, especially when arterial catheters are available 4, 2, 3
Capillary blood glucose measurements should be interpreted with caution as they may not accurately estimate arterial or plasma glucose values, especially in states of hypoperfusion 1, 5

In the initial phase of instability, monitoring should be done every 1-2 hours until glucose values and insulin infusion rates (if used) are stable 1, 2, 3
Once stable, monitoring can be done every 4 hours 1, 2

A protocolized approach is recommended for managing glucose levels in ICU patients with sepsis, starting insulin dosing when two consecutive blood glucose levels are >180 mg/dL 1, 2, 3
The goal should be to maintain a blood glucose level ≤180 mg/dL instead of a more stringent control ≤110 mg/dL 1, 2, 3
The American College of Critical Care Medicine recommends avoiding strict glucose control (<110 mg/dL) as it increases the risk of hypoglycemic events in sepsis 6