ICU · Pharmacology

Insulin & Hypoglycaemics — Pharmacology

Also known as Insulin · Hypoglycaemics · Insulin types · Actrapid · Metformin · Sulfonylurea · GLP-1 · SGLT2 inhibitor · Variable-rate insulin infusion · Fixed-rate insulin infusion · NICE-SUGAR · Euglycaemic DKA · Metformin-associated lactic acidosis

ICU insulin and hypoglycaemics. INSULIN TYPES classified by onset/duration: RAPID analogues (lispro, aspart, glulisine — monomeric — onset 10-20 min, duration 3-5 h); SHORT/soluble (regular/Actrapid — forms hexamers — onset 30-60 min, duration 6-8 h — the IV preparation for ICU); INTERMEDIATE (isophane/NPH — protamine + zinc complex — cloudy — onset 1-2 h, duration 12-18 h); LONG (glargine — precipitates at neutral pH, flat peakless ~24 h; detemir — albumin-bound via myristic acid); ULTRA-LONG (degludec — multi-hexamers, 42+ h; icodec weekly). ICU INSULIN USE: DKA fixed-rate insulin infusion (FRII) 0.1 U/kg/h until ketones cleared; HHS lower dose 0.05 U/kg/h after aggressive fluid resuscitation; stress hyperglycaemia via variable-rate insulin infusion (VRII / sliding scale) targeting moderate control per NICE-SUGAR (conventional target 10.0 mmol/L or less) (moderate control — tight control 4.5-6.0 increased mortality, overturning the Leuven trial); insulin-dextrose for hyperkalaemia (intracellular K shift); GIK high-dose insulin for beta-blocker/calcium-channel-blocker toxicity. ORAL HYPOGLYCAEMICS: METFORMIN (biguanide — activates AMP kinase — suppresses hepatic gluconeogenesis — non-hypoglycaemic — UKPDS-34 mortality benefit in overweight T2DM — metformin-associated lactic acidosis (MALA) in renal failure/hypoxia/sepsis — removed by haemodialysis); SULFONYLUREAS (gliclazide, glibenclamide — close beta-cell K-ATP channel — stimulate insulin release — hypoglycaemia risk, especially glibenclamide/elderly/renal); DPP-4 inhibitors (sitagliptin — prolong incretins, glucose-dependent, weight-neutral, CV-safe per TECOS); SGLT2 inhibitors (dapagliflozin, empagliflozin — block Na-glucose cotransporter in proximal tubule — glycosuria — CV/renal benefit (EMPA-REG, CANVAS, CREDENCE) — euglycaemic DKA risk); GLP-1 agonists (exenatide, liraglutide, semaglutide — incretin mimetics — weight loss — CV benefit per LEADER/SUSTAIN-6). HYPOGLYCAEMIA MANAGEMENT: rule of 15 (15 g carbohydrate, recheck at 15 min); severe — IV dextrose (50% is vesicant) and glucagon 1 mg IM; octreotide 50 mcg SC every 6 h for sulfonylurea-induced hypoglycaemia (inhibits insulin secretion).

Checked against its sources on 2 Sept 2026