Clinical staff (both doctors and nurses) in the study ICUs will undergo formal training and familiarisation with the insulin regimens by local study coordinators assisted by staff from the appropriate national study coordinating centre. Subsequently the administration of insulin will be adjusted by the intensive care doctors and nurses using the study algorithm accessed via the secure, password protected, encrypted study website. The study algorithm recommends insulin infusion rates whilst allowing clinician discretion, ultimate responsibility for the safe and effective use of insulin infusions remains with the treating clinicians