Low-dose intensive insulin therapy in patients with Acute Coronary Syndrome accompanied by Left Ventricular Failure: audit of two UK hospitals

Albarran, John W.; Manning, Nicola; Albarran, John

Abstract

© 2016 John Wiley & Sons Ltd Aims and Objectives: To determine whether a low-dose intravenous insulin regimen reduces blood glucose levels at a timely rate and associated side effects among patients with Acute Coronary Syndrome and Left Ventricular Failure. Background: Induced hypoglycaemia and the associated risks have questioned the benefits of intensive insulin therapy in patients presenting with raised blood glucose levels and Acute Coronary Syndromes. Local audit data identified that patients with Acute Coronary Syndrome and Left Ventricular Failure experienced more hypoglycaemic episodes than those with Acute Coronary Syndrome alone. Consequently, a new regimen of low-dose insulin for this group was implemented and audited over 12months. Design: Audit. Methods: Thirty-six consecutive patient notes with a diagnosis of Acute Coronary Syndrome and blood glucose of ≥10mmol/l treated with a new insulin therapy regimen were analysed. Data were extracted using a standardised form and entered into an Excel spreadsheet for analysis. Results: The mean age of the sample was 70years with 66% of subjects being men and 50% presenting with Acute Coronary Syndrome and Left Ventricular Failure. The low-dose regimen was effective in achieving normoglycaemia, (range 4–8mmol/l) for a consecutive six-hour period. This was achieved in 72% of patients and within a median time of 13hours. Conclusion: The audit suggests that a low-dose insulin regimen can effectively stabilise blood glucose in patients presenting with both Acute Coronary Syndrome and Left Ventricular Failure. The importance of regularly monitoring blood sugar levels is vital and highlights the role of nurses in minimising patient risk and promoting safety. Relevance to practice: Nurses are instrumental in the safe implementation of intensive insulin guidelines. Close monitoring of patients is essential, enabling timely adjustments to treatments and ensuring patient safety. Regular audits allow nurses to evaluate care provision and continue to drive practice forward.

Citation

Albarran, J. W., Manning, N., & Albarran, J. (2016). Low-dose intensive insulin therapy in patients with Acute Coronary Syndrome accompanied by Left Ventricular Failure: audit of two UK hospitals. Journal of Clinical Nursing, 25(19-20), 3001-3009. https://doi.org/10.1111/jocn.13257

• Journal Article Type: Article
• Acceptance Date: Feb 2, 2016
• Online Publication Date: Apr 27, 2016
• Publication Date: Oct 1, 2016
• Deposit Date: Feb 5, 2016
• Publicly Available Date: Apr 27, 2017
• Journal: Journal of Clinical Nursing
• Print ISSN: 0962-1067
• Electronic ISSN: 1365-2702
• Publisher: Wiley
• Peer Reviewed: Peer Reviewed
• Volume: 25
• Issue: 19-20
• Pages: 3001-3009
• DOI: https://doi.org/10.1111/jocn.13257
• Keywords: coronary care, audit, insulin regimes; acute coronary syndrome, left ventricular failure, hypoglycaemia, intensive insulin therapy, hyperglycaemia, safety
• Public URL: https://uwe-repository.worktribe.com/output/906288
• Publisher URL: http://dx.doi.org/10.1111/jocn.13257
• Additional Information: Additional Information : This is the peer reviewed version of the following article: Manning, N. and Albarran, J. (2016) Low-dose intensive insulin therapy in patients with Acute Coronary Syndrome accompanied by Left Ventricular Failure: Audit of two UK hospitals. Journal of Clinical Nursing. ISSN 0962-1067, which has been published in final form at http://dx.doi.org/10.1111/jocn.13257. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving.