Lightning rounds 60: The nuances of insulin, with Melissa Nestor

The podcast explores insulin usage in the ICU, questioning when and why it's administered, even to non-diabetic patients. It highlights the role of hyperglycemia as a stress response and the impact of medications like steroids and altered feeding patterns. The speakers advocate for A1c tests to differentiate between acute and chronic hyperglycemia, guiding decisions on endocrinology consultations and post-ICU care. The discussion contrasts ICU glucose management with outpatient approaches, emphasizing the ICU's focus on short-term, reactive control via sliding scales and insulin drips due to infection risks and immune dysfunction. They explore the nuances of insulin types (regular vs. rapid-acting) and long-acting insulins, especially for type 1 diabetics needing basal insulin, and stress incremental control over strict targets to minimize iatrogenic harm.