In the life-and-death race in the intensive care unit (ICU), blood glucose monitoring may seem ordinary, but it has become a key variable determining the prognosis of patients. Global data shows that for every 2mmol/L increase in blood sugar in critically ill patients, the mortality rate rises by 15%. The incidence of severe hypoglycemia (<2.5mmol/L) is as high as 10-20%, which can directly lead to brain damage and even death. Precise blood glucose monitoring and management have been upgraded from “routine nursing” to “core skills”, becoming an important indicator for measuring the quality of critical care care.
1. The “invisible storm” of blood sugar fluctuations in critically ill patients
In a critical condition, the patient’s body is in a strong stress response, the neuroendocrine system is disordered, and the balance of blood sugar metabolism is completely disrupted. This imbalance is not only a manifestation of the disease, but also an “invisible storm” that aggravates the condition and triggers complications.
1.1 The “Triple Fatal Blow” of Hyperglycemia
The harm of persistent hyperglycemia to critically ill patients far exceeds imagination:
The risk of infection has soared by 3 to 5 times: A high-glycemic environment provides a “nutrient medium” for bacteria and fungi, significantly increasing the incidence of nosocomial infections such as pneumonia and urinary tract infections
Multi-organ function-linked injury: For every blood glucose level exceeding 15mmol/L, the risk of acute kidney injury increases by 2.7 times, and the incidence of acute respiratory distress syndrome (ARDS) rises by 1.9 times
The mortality rate increases exponentially: Research shows that when the blood sugar of ICU patients remains consistently above 12mmol/L, the mortality rate is 2.3 times that of those with normal blood sugar. When it exceeds 20mmol/L, the mortality rate soars to 4.1 times
1.2 The “Instant Fatal Threat” of Hypoglycemia
The harm of hypoglycemia is often overlooked, but its impact on critically ill patients is more direct:
Irreversible brain damage: Brain tissue is almost entirely dependent on glucose for energy supply. Hypoglycemia lasting for more than six minutes can lead to neuronal necrosis, causing coma or even a vegetative state
A sharp increase in cardiovascular events: Hypoglycemia can induce malignant arrhythmias and myocardial infarction, with an incidence rate 3.2 times that of people with normal blood sugar
The mortality rate doubles: The mortality rate of patients with severe hypoglycemia (<2.5mmol/L) is as high as 38%, which is 2.8 times that of those with normal blood sugar
1.3 The “Hidden Harm” of Blood Glucose Fluctuations
In addition to hyperglycemia and hypoglycemia, the amplitude of blood sugar fluctuations is also an important factor affecting prognosis:
Aggravated oxidative stress damage: Fluctuations in blood sugar lead to an increase in the generation of free radicals in the body, and the degree of damage to vascular endothelial cells is 2.1 times that of stable hyperglycemia
Uncontrolled inflammatory response: Fluctuations in blood sugar can activate inflammatory pathways such as NF-κB, leading to a 1.7-fold increase in the incidence of systemic inflammatory response syndrome (SIRS)
Delayed recovery process: Patients with large fluctuations in blood sugar have a 32% longer ICU stay and a 45% increase in mechanical ventilation time
2. Precise Blood Glucose Monitor: From “Empirical Judgment” to “Scientific Decision-making”
Accurate blood glucose monitoring is the cornerstone of blood glucose management for critically ill patients. The traditional “timed monitoring” model can no longer meet clinical needs. Instead, a precise monitoring system that is “individualized, dynamic and multi-dimensional” has been adopted.
2.1 “Precise selection” of monitoring methods
The commonly used blood glucose monitoring methods in clinical practice each have their advantages and disadvantages, and the choice should be individualized based on the patient’s condition.
Arterial blood glucose monitoring: The gold standard, with the most accurate results, but it is complex to operate and causes significant trauma. It is suitable for patients with severe infections, shock, and other conditions that require precise blood glucose data
Venous blood glucose monitoring: The results are relatively accurate and the operation is relatively simple. It is suitable for routine monitoring when the condition is stable
Fingertip blood glucose monitoring: Fast and convenient, suitable for immediate bedside monitoring, but its accuracy is affected by factors such as operation norms and instrument calibration
Continuous glucose monitoring (CGM) : It tracks blood glucose changes in real time and can detect latent hyperglycemia/hypoglycemia. It is suitable for patients with large blood glucose fluctuations and insulin treatment
2.2 “Dynamic Adjustment” of Monitoring Frequency
The frequency of blood glucose monitoring for critically ill patients should be dynamically adjusted according to their condition
In the early stage of admission: Monitor every 1-2 hours to quickly assess the condition and adjust the treatment plan
Before and after the operation: Monitor once every 1-2 hours to prevent complications caused by postoperative blood sugar fluctuations
During insulin treatment: Monitor every 1-2 hours and adjust the insulin dosage in a timely manner according to changes in blood sugar
After the condition stabilizes: Monitor every 4 to 6 hours to maintain stable blood sugar levels
2.3 “Strict Control” of Monitoring Quality
Precise monitoring not only relies on advanced equipment but also requires strict quality control
Instrument calibration: The blood glucose meter should be calibrated once every three months to ensure the accuracy of the monitoring results
Standard operation: Clean your hands with warm water before blood collection. Choose to collect blood from the side of your fingertip to avoid excessive squeezing that may cause tissue fluid to mix in
Result review: Retest abnormal results to eliminate operational errors
Data management: Establish a blood glucose monitoring database, analyze the trend of blood glucose changes, and provide a basis for treatment adjustment
3. “Precise Implementation” of Clinical Practice
The core of precise blood glucose management lies in the precise implementation of clinical practice. Nursing staff need to master the closed-loop management process of “monitoring – assessment – intervention – feedback” to ensure that blood sugar is controlled within the target range.
3.1 “Individualized Setting” of Blood Glucose Control Targets
The blood sugar control targets for critically ill patients should be set on an individual basis to avoid a one-size-fits-all approach
For general patients: Blood sugar should be controlled at 6-12mmol/L to prevent hypoglycemia
Patients with brain injury: Keep blood sugar at 7.8-10mmol/L to prevent hypoglycemia from aggravating brain injury
Elderly patients: Blood sugar should be controlled at 8-14mmol/L to balance the risks of hyperglycemia and hypoglycemia
For pediatric patients: Blood sugar should be controlled at 5-10mmol/L, and adjusted according to age and weight
3.2 “Precise Implementation” of Insulin Therapy
Insulin is the main means of blood sugar control for critically ill patients and needs to be precisely implemented:
Insulin pump preparation: Commonly used are NS 50ml+RI 50U (1ml=1U RI) or NS 50ml+RI 100U (1ml=2U RI).
Dosage adjustment: Dynamically adjust the insulin dosage based on blood sugar levels to avoid excessive fluctuations in blood sugar
Hypoglycemic prevention: Closely monitor blood glucose. When blood glucose is less than 4mmol/L, immediately administer a 40-60ml intravenous injection of 50%GS
Effect evaluation: Monitor blood sugar every 1-2 hours to assess the effect of insulin treatment and adjust the dosage in a timely manner
3.3 “Precision Intervention” for Complication Prevention
Precise blood glucose management should also focus on the prevention of complications:
Infection prevention: Strictly follow aseptic procedures, enhance nutritional support, and maintain blood sugar levels within the target range
Organ protection: Monitor liver and kidney functions, myocardial enzymes and other indicators to promptly detect signs of organ damage
Thrombosis prevention: Assess the risk of thrombosis, provide anticoagulant therapy, and encourage early activity
Neuroprotection: Prevent hypoglycemia and maintain stable cerebral perfusion pressure
4. Future Outlook: Technology Empowering precise blood glucose Management
With the continuous development of technology, new breakthroughs will be made in blood sugar management for critically ill patients:
Continuous blood glucose monitoring technology: More accurate and convenient CGM devices will be widely applied to achieve real-time monitoring and early warning of blood glucose
Artificial intelligence-assisted decision-making: Utilizing AI algorithms to analyze blood glucose data, provide individualized treatment suggestions, and optimize blood glucose management plans
Closed-loop insulin infusion system: It realizes the automatic control of blood glucose monitoring and insulin infusion, improving the accuracy and safety of blood glucose control
Multi-disciplinary collaboration model: Through the collaboration of multi-disciplinary teams such as doctors, nurses, nutritionists, and pharmacists, more comprehensive and personalized blood glucose management services are provided for patients
Precise blood glucose monitoring and management is a key entry point for improving the quality of critical care nursing. Nursing staff need to constantly improve their professional skills and establish an “individualized, dynamic and multi-dimensional” precise blood glucose management system. With more accurate monitoring, more scientific assessment and more effective intervention, they can build a solid “blood glucose safety defense line” for critically ill patients. In the life-and-death race in the ICU, every precise blood sugar monitoring is a sign of reverence and protection for life. Every scientific adjustment of blood sugar levels brings hope of survival to patients. Let’s take precise blood sugar management as the starting point, continuously improve the quality of critical care, and safeguard the life and health of patients.
Post time: Feb-04-2026