| 
The Hospital Intensive Insulin Program (HIIP) is
an inpatient program developed and managed by Dr.
Roma Gianchandani, Assistant Professor in the Division
of MEND, Department of Internal Medicine.
Dr. Gianchandani, along with a team of doctors and
physician assistants have implemented an intensive
insulin protocol for the management of diabetic/hyperglycemic
inpatients. The importance of intensive diabetes control
in the outpatient setting is now undisputed and there
are similar data from several inpatient intensive
care settings.
Hyperglycemia in critically ill patients is an important
correctable risk factor for inpatient morbidity and
mortality. Data supporting the use of an insulin infusion
to correct hyperglycemia are available from the cardiothoracic
surgery, cardiology and critical care literature.
After major surgical procedures and in critical medical
illnesses, patients (both diabetic and nondiabetic)
develop hyperglycemia as a result of stress induced
insulin resistence. The major cause of hyperglycemia
is the release of counterregulatory stress hormones
(namely cortisol, growth hormone, catecholamines and
glucagon) and local tissue cytokines. Excessive nutritional
support, sepsis, hypothermia, hypoxemia, uremia and
cirrhosis further reduce insulin production or worsen
insulin resistence.
The hospitalized diabetic patient has a 3 - 4 fold
higher complication rate due to various metabolic
and immunological alterations caused by high blood
sugars. Several studies demonstrate an improvement
in morbidity and mortality when hyperglycemia is managed
with an intensive insulin regimen post cardiothoracic
surgery, myocardial infarction and other intensive
care settings. Based on this data, several major surgery
and bypass programs have adopted intensive insulin
management as standard of care with improved clinical
outcome.
PROGRAM PERSONNEL:
|
