Minimizing Errors When Treating Diabetes Mellitus with Severe Hyperglycemia or Ketoacidosis

SLU ID 21-003 | Unified insulin infusion protocol (UnIIP)

Background

Patients with diabetes mellitus with severe hyperglycemia or ketoacidosis are at high risk of morbidity (such as worsening of infections, sepsis or acute worsening of heart disease), and are at a high risk of death. They are admitted to intensive care units for management of their critical illness. Either inadequate correction of the hyperglycemia or ketoacidosis or excessive insulin treatment with resulting hypoglycemia may be associated with increased death. Various management protocols have been published in the medical literature, however these protocols require expert physician management and extensive medical personnel interactions and training. These published protocols require on site "paper" calculations of glucose changes and insulin adjustments and are subject to error.

Overview

Researchers at Saint Louis University have developed a simplified, user friendly, insulin infusion protocol which may be readily incorporated into existing electronic medical record systems (e.g., EPIC). The protocol (Unified Insulin Infusion Protocol [Unified IIP]) has been validated for use in intensive care settings and post-operative patients who are not able to eat and require tight metabolic glycemic control.

Benefits

The potential benefits of this technology include:

• Minimizing inadequate correction of the hyperglycemia or ketoacidosis

• Minimizing excessive insulin treatment

• Minimizing the risk of death

• Minimizing the cognitive burden on healthcare staff

Applications

The potential applications of this technology include:

• Treating patients with diabetes mellitus with severe hyperglycemia or ketoacidosis

Opportunity

Saint Louis University is seeking a partner to further develop and commercialize this technology.

References

• Gupta, D., Kirn, M., Jamkhana, Z. A., Lee, R., Albert, S. G., & Rollins, K. M. (2017). A unified Hyperglycemia and Diabetic ketoacidosis (DKA) insulin infusion protocol based on an Excel algorithm and implemented via Electronic Medical Record (EMR) in Intensive Care Units. Diabetes & Metabolic Syndrome: Clinical Research & Reviews, 11(4), 265-271. doi:10.1016/j.dsx.2016.09.008

• Gupta, D., Prasad, A., Siddiqui, F., Sitaula, S, & Albert, S. G. (2019). Insulin infusion responses in diabetic ketoacidosis alone and with a mixed hypochloremic alkalosis. Diabetes & Metabolic Syndrome: Clinical Research & Reviews, 13(1), 216-221. doi: 10.1016/j.dsx.2018.08.015. PMID: 30641700