Hospitals & Services
The department of Intensive Care uses a method of controlling blood glucose by adjusting both the nutrition (carbohydrate load) and insulin in order to provide tight and safe control. This system is called STAR, Stochastic TARgeted Glycaemic control). This results from 10 years research at the Centre for Bioengineering, University of Canterbury. The models developed have produced tighter and safer control.
There is good evidence that hypoglycaemia and hyperglycaemia contribute to organ failure and mortality. However, it is difficult to control these parameters well with a one-size fits all protocol. Specifically, when simple (heuristic) protocols have been implemented, patient centred outcome improvements have not been realised. Since the introduction of model-based glycaemic control in September 2005, the mortality of patients who have spent more than three days in Intensive Care, has been reduced by 30%.
The STAR protocol uses an android tablet with simple instructions that guide both the feed and insulin inputs. These are calculated every one to three hours.
As a general rule, all patients who are hyperglycaemic (glucose > 8mmol/l) and who are expected to remain in ICU for at least 24 hours should be commenced on STAR.
STAR is designed to be used in critically ill patients. This method uses one to three hourly boluses of insulin, which is determined by the likelihood of developing hypoglycaemia. Where a patient is particularly insulin resistant, a background infusion started may be recommended at 1-2 units per hour. The background infusion must be stopped if glucose levels are less that 4.0 mmol/L. STAR should be ceased after at least 6 consecutive hours, without insulin administration.
Please ask for help if you are uncertain about the application of STAR to Intensive Care patients.
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