OBJECTIVE—In a recent randomized controlled trial, lowering blood glucose levels to 80–110 mg/dl improved clinical outcomes
in critically ill patients. In that study, the insulin infusion protocol (IIP) used to normalize blood glucose levels provided valuable
guidelines for adjusting insulin therapy. In our hands, however, ongoing expert supervision was required to effectively manage
the insulin infusions. This work describes our early experience with a safe, effective, nurse-implemented IIP that provides
detailed insulin dosing instructions and requires minimal physician input.

RESEARCH DESIGN AND METHODS—We collected data from 52 medical intensive care unit (MICU) patients who were
placed on the IIP. Blood glucose levels were the primary outcome measurement. Relevant clinical variables and insulin
requirements were also recorded. MICU nurses were surveyed regarding their experience with the IIP.

RESULTS—To date, our IIP has been employed 69 times in 52 patients admitted to an MICU. Using the IIP, the median
time to reach target blood glucose levels (100–139 mg/dl) was 9 h. Once blood glucose levels fell below 140 mg/dl, 52%
of 5,808 subsequent hourly blood glucose values fell within our narrow target range; 66% within a "clinically desirable"
range of 80–139 mg/dl; and 93% within a "clinically acceptable" range of 80–199 mg/dl. Only 20 (0.3%) blood glucose
values were <60 mg/dl, none of which resulted in clinically significant adverse events. In general, the IIP was readily
accepted by our MICU nursing staff, most of whom rated the protocol as both clinically effective and easy to use.

CONCLUSIONS—Our nurse-implemented IIP is safe and effective in improving glycemic control in critically ill patients.