What do you recommend for treatment of hyperglycemia in patients who have undergone coronary artery bypass?
—JEFFREY ARBOUR, PA-C, Saline, Mich
Clinical evidence supports the use of intensive gylcemic control. Insulin drip therapy to maintain a blood glucose level of 80-110 mg/dL reduces morbidity and mortality. Initiation of a specific protocol for an insulin drip for each institution is suggested. There are two well-established insulin drip protocols; the Yale Protocol (Diabetes Care. 2004;27:461-467. Available at care.diabetesjournals.org/cgi /content/full/27/2/461. Accessed June 12, 2009) and the Portland Protocol (www.providence.org, search for insulin protocol. Accessed June 12, 2009). Regardless of which protocol is used, the goal is to provide a standardized implemented mechanism of glucose control. In New York State, patients must have a blood glucose <160 mg/dL by 6 AM the day after cardiac surgery.
—Debra Kleinschmidt, PhD, PA (129-4)