Recommandations francophones pour le contrôle glycémique en réanimation (patients diabétiques et pédiatrie exclus)*

Hyperglycemia or “stress diabetes” results essentially from insulin resistance in critically ill patients. Hyperglycemia, inflammation and hypoxia are responsible of a self-perpetuating vicious circle. While the risks of hypoglycemia are well known, the deleterious effects of hyperglycemia in critical situations are only considered from 10 years. Control of glycemia in intensive care unit is no longer discussed. However, despite a very rich literature, the results of clinical trials are conflicting. The heterogeneity of trials makes data difficult to interpret. Thus, it is presently impossible to recommend only one glycemic target appropriate for all situations. Glycemic control strategies increase the risk of hypoglycaemia thereby requiring frequent check of glycemia, even in the absence of neurological signs. We advise to limit the total amount of glucose administration to a maximum of 200g/day without exceeding 100g/day for intravenous glucose. Glycemic measurements on capillary blood samples can give inaccurate values, which is not suitable for critically patients. Thus, in case of hypoglycemia, patients with shock or edemas, glycemia measurements must be verified on an arterial or venous blood sample in the laboratory. Physicians and nurses must know exactly the physicochemical characteristics of their material to avoid some serious errors. Each team must implement its own protocol of glycemic control considering his technical and human structural constraints.