A 9-year-old child is admitted to the pediatric intensive care unit (PICU) with sepsis secondary to a ruptured appendix. The child requires mechanical ventilation and an epinephrine infusion via a central line. Admission blood glucose is 230 mg/dL, and point-of-care glucose monitoring is being performed every 1–2 hours. If a tight glycemic control protocol targeting 72–126 mg/dL is initiated, which of the following outcomes is most likely compared to conventional glucose management?

A 48-year-old woman with type 2 diabetes is admitted to the intensive care unit for severe sepsis and multiorgan dysfunction. On admission her blood glucose is 380 mg/dL and her HbA1c is 9.2%. Her family reports that she often struggles to afford her diabetes medications and sometimes misses appointments because of transportation problems. Which of the following interventions is most critical to address the foundational barriers contributing to her long-term dysglycemia?

A 65-year-old man is admitted to the intensive care unit for septic shock secondary to pneumonia. He is on mechanical ventilation and receiving a norepinephrine infusion via a central line. His initial blood glucose is 250 mg/dL, and a point-of-care HbA1c is 6.0%. He has no history of diabetes. Which of the following best characterizes his glycemic status and its clinical implication?

A 10-year-old girl is admitted to the pediatric intensive care unit (PICU) with septic shock secondary to peritonitis. She is intubated, mechanically ventilated, and requires a continuous norepinephrine infusion. Her initial blood glucose is 230 mg/dL, and an insulin infusion is initiated with a target blood glucose range of 72–126 mg/dL. Based on evidence from landmark trials evaluating this glycemic control strategy in critically ill children, which outcome is most likely to be increased?

A 7-year-old boy is in the pediatric ICU following severe asthma exacerbation requiring intubation and mechanical ventilation. He is on continuous nebulized albuterol and IV corticosteroids. His blood glucose has remained above 220 mg/dL for the past 24 hours. Which is the most appropriate approach to glycemic management in this patient?

A 65-year-old man is admitted to the intensive care unit for severe sepsis secondary to pneumonia. He requires mechanical ventilation and a continuous norepinephrine infusion administered via a central venous catheter. He has no known history of diabetes. Upon admission, his blood glucose is 320 mg/dL and his HbA1c is 5.8%. Over the past 6 hours, his glucose levels have remained persistently above 250 mg/dL despite initial fluid resuscitation. Which of the following is the most appropriate initial intervention for managing this patient’s hyperglycemia?

A 65-year-old male is admitted to the medical intensive care unit, currently intubated and on mechanical ventilation for acute respiratory failure secondary to severe pneumonia. He is receiving a continuous norepinephrine infusion through a central venous catheter for septic shock. His medical history includes type 2 diabetes mellitus, with a baseline HbA1c of 8.5% on admission. Initial blood glucose was 350 mg/dL, and he was started on a continuous insulin infusion targeting a blood glucose range of 80–110 mg/dL. Over the past 12 hours, despite multiple reductions in the insulin infusion rate, his blood glucose has fluctuated significantly, with two episodes of hypoglycemia (60 mg/dL and 55 mg/dL) requiring dextrose administration. Considering the patient’s history of diabetes and recurrent hypoglycemic episodes while on an insulin infusion, which of the following adjustments to the glycemic management plan should be prioritized to optimize patient safety and outcomes?

A 10-year-old, 35-kg child is in the pediatric intensive care unit for septic shock secondary to a perforated appendix. The patient is mechanically ventilated, receiving a norepinephrine infusion via a central line, and on a continuous insulin infusion targeting a blood glucose of 110–150 mg/dL. A point-of-care glucose measurement of 68 mg/dL prompted a temporary hold of the insulin. Given this hypoglycemic episode, which adjustment to glycemic management is most appropriate?

A 62-year-old man with septic shock is managed in the ICU with assist-control ventilation and a continuous norepinephrine infusion via a central line. He weighs 80 kg and is receiving continuous enteral nutrition at 50 mL/hour of a 1 kcal/mL polymeric formula. He has developed acute kidney injury (creatinine 3.2 mg/dL; baseline 0.9 mg/dL) but is not on renal replacement therapy. His HbA1c is 5.8%. He is receiving a continuous insulin infusion at 2 units/hour, following an institutional protocol that adjusts the rate by 1 unit/hour for every 20 mg/dL deviation from target. Over the past 12 hours, arterial blood glucose readings have been 215, 198, 165, 122, 190, and 145 mg/dL. Given this patient’s clinical status, which of the following is the most appropriate immediate adjustment to the insulin infusion?

A 14-year-old boy is admitted to the pediatric intensive care unit for severe sepsis requiring mechanical ventilation and a continuous norepinephrine infusion. His admission glucose was 185 mg/dL, but over the past 12 hours his point-of-care values have ranged from 280–320 mg/dL despite no exogenous dextrose. His current blood glucose is 305 mg/dL. Which of the following is the most appropriate initial intervention to manage his hyperglycemia?