UMEM Educational Pearls

Category: Critical Care

Title: Insulin use in the critically ill

Keywords: insulin, hyperglycemia, critically ill (PubMed Search)

Posted: 9/30/2008 by Mike Winters, MD (Updated: 3/5/2024)
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Subcutaneous Insulin in the Critically Ill

  • Although intensive insulin therapy in the critically ill remains controversial and a matter of much debate, hyperglycemia is common in the critically ill ED patient
  • Hyperglycemia is associated with worse outcomes in this patient population
  • When treating hyperglycemia in the critically ill ED patient, use caution with subcutaneous insulin
  • Absoprtion of insulin administered subcutaneously is slow, erratic, and highly variable often due to poor perfusion, hypotension, and/or vasopressor therapy
  • In these patients, IV insulin is a better route of administration and leads to more reliable control of hyperglycemia
  • Recall that the onset of action of insulin given IV is 10 - 30 minutes, with a duration of action of about 1 hour


Shipman K, Frankel HL. Do not use subcutaneous insulin in the intensive care unit population. In: Marcucci L, et al. Avoiding Common ICU Errors. Lippincott Williams & Wilkins; Phildelphia, PA, 2007