Methods:

Whether introduce intensive or conventional therapy
Intensive insulin therapy (IIT) is often started when blood glucose level exceeds 6.1mmol/l and is adjusted to maintain normoglycaemia, whereas conventional insulin therapy (CIT) is started only when blood glucose level exceeds 12mmol/l, often adjusted to maintain a blood glucose level of between 10 and 11mmol/l.

Risks assessment
Intensive insulin therapy is not entirely beneficial. Failure to control blood glucose level is common and may considerably affect the overall impact of insulin treatment strategies on mortality.

Investigating on length of the treatment
Different research evidence suggests that length of stay in the ICU with intensive insulin therapy can impact on the outcome of these patients. It found that IIT could reduce morbidity and mortality among patients who stayed in the ICU for 3 or more days and that only long-term glycaemic control have marked beneficial effects.

Analysis of timing of administration
Some studies have suggested possible harmful effect of IIT on short-term stayers, as a result have proposed a conservative approach of delaying IIT for hyperglycaemia in ICU patients until 2-3 days after admission. After categorizing by the length of time elapsed after ICU admission before initiation of insulin, there was a significant trend toward increasing mortality with increasing delay in initiation of therapy.

Results and Conclusion:

Administration of insulin has led to reduced morbidity and mortality among most patients who stayed in the ICU for 3 days or over. They

would have a greater chance of survival and could recover quicker if insulin is administered to adopt strict control of plasma glucose levels

at earliest time possible.