(970) Hyperinsulinemia Euglycemia Therapy Protocol Medication Use Evaluation

Introduction: Hyperinsulinemia euglycemia therapy (HIET) decreases systemic vascular resistance, allows myocardial cells to uptake, and use glucose, and has a direct inotropic effect leading to its beneficial hemodynamic effects for toxic exposure to calcium channel blockers and beta blockers. Hypoglycemia (blood glucose < 70 mg/dL) is a commonly reported adverse effect with HIET; therefore, appropriate titration of insulin and dextrose infusions with careful monitoring of serum glucose levels is required. The objective of this medication use evaluation was to collect, analyze, and report hypoglycemia events during HIET.

Methods: This was a single center retrospective review of patients admitted to University of Cincinnati Medical Center or West Chester Hospital from June 12th, 2018, to October 30th, 2022, treated with high dose insulin infusion ordered for a known or suspected calcium channel or beta blocker overdose.

Results: Majority of patients were middle aged, female (84.6%), required vasopressor support (100%), and the most common agent ingested was amlodipine (61.5%). Patients were maintained on the insulin and dextrose infusions for a median of 58.2 and 93 hours, respectively. Of the 13 patients initiated on HIET, 2 patients (15.4%) experienced a hypoglycemic event with a total of 3 events identified overall. There was a relatively high rate of institutional protocol compliance. Patients maintained a blood glucose within goal (150-250 mg/dL) 83% of the time and 100% of time patients were appropriately titrated on the insulin infusion base on hemodynamic parameters per protocol. 76.7% of patients were escalated to 70% dextrose concentration from a 10% concentration infusion. The cost per patient based on a median duration of 93 hours and median volume of 1.4L/24 hours, was $59.89 for the 70% dextrose infusion compared to $71.87 with 10% dextrose concentration.

Conclusions: There was high protocol compliance with a low hypoglycemic event rate. Based on the results of this evaluation, no adjustments were made to infusion titration parameters. However, the opportunity of product optimization along with cost savings was identified. Protocol improvements included starting 70% dextrose at initiation of therapy with 10% dextrose reserved when central access is not available.