Tight glycemic control

Intensive insulin therapy consists in insulin protocols targeting euglycemia (blood glucose 80-110 mg/dL). After initial enthusiasm for the positive results of the Leuven trials, concerns were raised about the incidence of hypoglycemia and extra-mortality in both surgical and medical patients. Despite a clear physiologic rationale for glucose control in critically ill patients, the best target level of glycemia, particularly for previously non-diabetic patients, is still debated. Aiming at glycemic stability may be more beneficial. Concomitant administration of insulin and nutrition is necessary and may exert positive effects on metabolism of critically ill patients, though further studies are necessary to confirm these findings. Dynamic protocols and automated insulin infusion may help to achieve a more stable and safer glycemic control.