Glycemic control in the burn intensive care unit: focus on the role of anemia in glucose measurement

Abstract

Glycemic control with intensive insulin therapy (IIT) has received widespread adoption secondary to findings of improved clinical outcomes and survival in the burn population. Severe burn as a model for trauma is characterized by a hypermetabolic state, hyperglycemia, and insulin resistance. In this article, we review the findings of a burn center research facility in terms of understanding glucose management. The conferred benefits from IIT, our findings of poor outcomes associated with glycemic variability, advantages from preserved diurnal variation of glucose and insulin, and impacts of glucometer error and hematocrit correction factor are discussed. We conclude with direction for further study and the need for a reliable continuous glucose monitoring system. Such efforts will further the endeavor for achieving adequate glycemic control in order to assess the efficacy of target ranges and use of IIT.

Figure 1.

Circadian rhythm of serum glucose levels during first week of ICU stay for burn patients. Reprinted from The American Journal of Surgery with permission from Elsevier.

Figure 2.

Effect of HCT on glucometer performance. Polycythemic samples result in underestimation of serum glucose by single-channel glucometers; anemic samples cause glucose overestimation. The original blood volume was 1.67 dl.

Figure 3.

Glucometer error increases in a linearly as HCT decreases.