The Effect of Glargine as Basal Insulin Support for Recovering Critically Ill and High Dependency Unit Patients: An In Silico Study

Many critically ill patients are benefiting from extensive research done in tight glucose control (TGC) within the ICU. But moderate to high levels of hyperglycaemia are still tolerated within high dependency (HDU) and surgical units. The use and benefits of insulin protocols within these units have not yet been addressed in the literature. The management of tight glycaemic control still remains under the influence of ineffective standards characterized by tolerance for hyperglycaemia and a reluctance to use insulin intensively.A validated Glargine and intravenous insulin-glucose pharmacodynamic model are presented. Virtual trial results on 16 stable ICU patients showed that Glargine can provide effective blood glucose management for these long term recovering patients. An initial intravenous injection and higher Glargine dosing is required for the first day to quickly lower elevated blood glucose levels. However, once patient's blood glucose levels are within a desirable range, Glargine alone can provide effective glycaemic management, thus reducing nursing effort. Median blood glucose for the entire cohort when simulated with the combination of Glargine and an intravenous insulin injection is 6.5 with interquartile range of [5.6, 7.5]. The 90% confidence interval is [4.6, 9.7] with no occurrence of hypoglycaemia. This in silico study provides a first virtual trial analysis of the in-hospital transition between intravenous and subcutaneous insulin for TGC.