Glycaemic Control in the Critically Ill Patients at the Critical Care Unit, Kenyatta National Hospital

Abstract

Objective-To study the patterns of glycaemic control in the critically ill patients admitted at the critical care unit, Kenyatta National Hospital, (CCU-KNH). Design-A prospective cross-sectional study. Setting-Critical Care Unit, Kenyatta National Hospital. Subjects-critically ill patients admitted at the CCU-KNH. Methods- Over three months, data on blood sugar determinations as done on patients on admission to the CCU-KNH and subsequently the determinations done routinely on the patients for twenty four hours follow up period while still admitted in the unit. Other data collected included diabetes mellitus status, treatment with steroids and modes of feeding. Results-A total of a hundred and ninety six patients were recruited. The mean random blood glucose on admission was 8.1mmol/l, while the mean random blood glucose at 0-6 hours post admission was 7.7mmol/l, 6-12 hours was 8.4mmol/l, 12-18hours was 7.4mmol/l and at 18-24hours was 7.3mmol/l. The commonest corrective measure for hyperglycaemia increasing the dose of insulin infusion whereas for hypoglycaemia, it was infusion with 50% dextrose solution. Only 7% of the patients had diabetes mellitus. 21% of the patients were on treatment with steroids and there was mostly no statistically significant difference between the glucose profiles of those on steroids and those without except at between 6-12 hours post admission. The commonest mode of feeding was enteral and there were no significant differences in glucose profiles among the various modes of feeding. Conclusion- Majority of the patients admitted at the CCU-KNH have random blood glucose values that are well with the normal range. More focused corrective measures need to be adopted for the few patients who have deranged blood glucose values. A chart to record details regarding blood glucose management needs to be availed.