Menu
While 10% of the US population has diabetes, one-third of all hospitalized patients require insulin therapy to regulate blood sugar during their stay. Coupled with SARS-CoV-2, which causes COVID-19, diabetes and uncontrolled hyperglycemia are high-risk factors for poor outcomes in patients with COVID-19 including an increased risk of severe illness or death. This is exacerbated by the fact that hundreds of medications impact blood glucose levels and cause insulin resistance.
Steroids are one of these medications, making treating patients with COVID-19 increasingly challenging. The reason? Every patient admitted to the ICU with COVID-19 will likely receive a 6mg equivalent of dexamethasone daily. What’s alarming about this is nearly all patients with diabetes will develop hyperglycemia on steroids and more than half of patients without diabetes will have hyperglycemia on steroids. Extensive research has shown that inpatient hyperglycemia – irrespective of a diabetes diagnosis – is associated with an increased risk of complications and mortality, longer hospital stays, and higher readmission rates.
Glytec published research in April 2020 that examined rates of mortality and complications in COVID-19 patients that experienced hyperglycemia. Our study showed that mortality rates for hospitalized COVID-19 patients with diabetes were four times greater than those without diabetes. The research also showed that mortality rates were seven times higher for people without diabetes who then experienced hyperglycemia during their hospital stay. An additional follow-up study from Glytec defined an opportunity window for managing hospitalized COVID-19 patient blood glucose levels finding that non-critically ill patients who remained severely hyperglycemic after two to three days experienced a seven times higher mortality rate than those who achieved normoglycemia in the same period.
While steroid-induced hyperglycemia is to be expected, many patients with COVID-19 appear to also develop a more extreme form of insulin resistance, requiring large amounts of the drug. AdventHealth East Orlando, a 1,368-bed facility in central Florida, noted this phenomenon early in the pandemic. Many of their patients were requiring extremely high doses of IV insulin, which is typically administered for those with DKA, HHS or severe hyperglycemia (>300 mg/dl). Generally, 50 to 100 units per hour would be a maximum allowable infusion rate in a hospital, though many insulin protocols don’t dose more than 20-40 units per hour. The cases at AdventHealth East Orlando were so severe that some patients needed up to 500 units per hour of IV insulin.
AdventHealth East Orlando monitored four of these patients, all of whom were critically ill and on mechanical ventilation prior to requiring IV insulin. Among these cases, three patients had no history of insulin therapy and two required infusion rates up to 500 units per hour. Extremely high rates of insulin infusion can lead to instances of severe hypoglycemia, if protocols are not managed well, insulin resistance changes suddenly, or glucose checks are not timely.
AdventHealth East Orlando managed these IV insulin infusions by deploying Glucommander™, an algorithm-driven insulin dosing software at the heart of Glytec's eGlycemic Management System® software. Despite the high rates of IV insulin, Glucommander’s ability to learn each patient’s insulin sensitivity and anticipate future needs resulted in zero cases of severe hypoglycemia and enabled clinicians to utilize a variety of treatment regimens for its critically ill patients.
Proper glycemic management is critical to improving patient outcomes, especially those diagnosed with COVID-19 and requiring abnormally high rates of insulin infusions. AdventHealth East Orlando’s patient review highlights the extreme insulin resistance some patients with COVID-19 faced, that they can be safely managed with an eGMS, and the need for further studies evaluating insulin resistance in patients with COVID-19.
To learn more about AdventHealth East Orlando’s study, visit: https://drc.bmj.com/content/9/2/e002415
MAR-0000771 Rev 1.0
