Management of Hyperglycemia During Enteral and Parenteral Nutrition Therapy

Overview

Journal Curr Diab Rep

Publisher Current Science

Specialty Endocrinology

Date 2012 Oct 16

PMID 23065369

Citations 38

Authors

Aidar R Gosmanov

Guillermo E Umpierrez

Affiliations

Soon will be listed here.

Abstract

Hyperglycemia is a frequent complication of enteral and parenteral nutrition in hospitalized patients. Extensive evidence from observational studies indicates that the development of hyperglycemia during parenteral and enteral nutrition is associated with an increased risk of death and infectious complications. There are no specific guidelines recommending glycemic targets and effective strategies for the management of hyperglycemia during specialized nutritional support. Managing hyperglycemia in these patients should include optimization of carbohydrate content and administration of intravenous or subcutaneous insulin therapy. The administration of continuous insulin infusion and insulin addition to nutrition bag are efficient approaches to control hyperglycemia during parenteral nutrition. Subcutaneous administration of long-acting insulin with scheduled or corrective doses of short-acting insulin is superior to the sliding scale insulin strategy in patients receiving enteral feedings. Randomized controlled studies are needed to evaluate safe and effective therapeutic strategies for the management of hyperglycemia in patients receiving nutritional support.

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References

Anderson A, Palmer D, MacFie J . Peripheral parenteral nutrition. Br J Surg. 2003; 90(9):1048-54. DOI: 10.1002/bjs.4328. View

Sajbel T, Dutro M, Radway P . Use of separate insulin infusions with total parenteral nutrition. JPEN J Parenter Enteral Nutr. 1987; 11(1):97-9. DOI: 10.1177/014860718701100197. View

Askanazi J, Weissman C, Rosenbaum S, HYMAN A, Milic-Emili J, Kinney J . Nutrition and the respiratory system. Crit Care Med. 1982; 10(3):163-72. DOI: 10.1097/00003246-198203000-00005. View

Valero M, Leon-Sanz M, Escobar I, Gomis P, de la Camara A, Moreno J . Evaluation of nonglucose carbohydrates in parenteral nutrition for diabetic patients. Eur J Clin Nutr. 2002; 55(12):1111-6. DOI: 10.1038/sj.ejcn.1601274. View

Bienso R, Ringholm S, Kiilerich K, Aachmann-Andersen N, Krogh-Madsen R, Guerra B . GLUT4 and glycogen synthase are key players in bed rest-induced insulin resistance. Diabetes. 2012; 61(5):1090-9. PMC: 3331744. DOI: 10.2337/db11-0884. View

Cheung N, Napier B, Zaccaria C, Fletcher J . Hyperglycemia is associated with adverse outcomes in patients receiving total parenteral nutrition. Diabetes Care. 2005; 28(10):2367-71. DOI: 10.2337/diacare.28.10.2367. View

Elia M, Ceriello A, Laube H, Sinclair A, Engfer M, Stratton R . Enteral nutritional support and use of diabetes-specific formulas for patients with diabetes: a systematic review and meta-analysis. Diabetes Care. 2005; 28(9):2267-79. DOI: 10.2337/diacare.28.9.2267. View

Cresci G . Targeting the use of specialized nutritional formulas in surgery and critical care. JPEN J Parenter Enteral Nutr. 2005; 29(1 Suppl):S92-5. DOI: 10.1177/01486071050290S1S92. View

McMahon M . Management of parenteral nutrition in acutely ill patients with hyperglycemia. Nutr Clin Pract. 2005; 19(2):120-8. DOI: 10.1177/0115426504019002120. View

10.

Baum D, Porte Jr D . Stress hyperglycemia and the adrenergic regulation of pancreatic hormones in hypoxia. Metabolism. 1980; 29(11 Suppl 1):1176-85. DOI: 10.1016/0026-0495(80)90027-x. View

11.

Kreymann K, Berger M, Deutz N, Hiesmayr M, Jolliet P, Kazandjiev G . ESPEN Guidelines on Enteral Nutrition: Intensive care. Clin Nutr. 2006; 25(2):210-23. DOI: 10.1016/j.clnu.2006.01.021. View

12.

Cook A, Burkitt D, McDonald L, Sublett L . Evaluation of glycemic control using NPH insulin sliding scale versus insulin aspart sliding scale in continuously tube-fed patients. Nutr Clin Pract. 2009; 24(6):718-22. DOI: 10.1177/0884533609351531. View

13.

Craig L, Nicholson S, SILVERSTONE F, Kennedy R . Use of a reduced-carbohydrate, modified-fat enteral formula for improving metabolic control and clinical outcomes in long-term care residents with type 2 diabetes: results of a pilot trial. Nutrition. 1998; 14(6):529-34. DOI: 10.1016/s0899-9007(98)00062-8. View

14.

Umpierrez G, Jones S, Smiley D, Mulligan P, Keyler T, Temponi A . Insulin analogs versus human insulin in the treatment of patients with diabetic ketoacidosis: a randomized controlled trial. Diabetes Care. 2009; 32(7):1164-9. PMC: 2699711. DOI: 10.2337/dc09-0169. View

15.

Pohl M, Mayr P, Mertl-Roetzer M, Lauster F, Lerch M, Eriksen J . Glycaemic control in type II diabetic tube-fed patients with a new enteral formula low in carbohydrates and high in monounsaturated fatty acids: a randomised controlled trial. Eur J Clin Nutr. 2005; 59(11):1221-32. DOI: 10.1038/sj.ejcn.1602232. View

16.

Singer P, Berger M, Van den Berghe G, Biolo G, Calder P, Forbes A . ESPEN Guidelines on Parenteral Nutrition: intensive care. Clin Nutr. 2009; 28(4):387-400. DOI: 10.1016/j.clnu.2009.04.024. View

17.

Marik P, Preiser J . Toward understanding tight glycemic control in the ICU: a systematic review and metaanalysis. Chest. 2009; 137(3):544-51. DOI: 10.1378/chest.09-1737. View

18.

Charney P, Hertzler S . Management of blood glucose and diabetes in the critically ill patient receiving enteral feeding. Nutr Clin Pract. 2005; 19(2):129-36. DOI: 10.1177/0115426504019002129. View

19.

Pasquel F, Spiegelman R, McCauley M, Smiley D, Umpierrez D, Johnson R . Hyperglycemia during total parenteral nutrition: an important marker of poor outcome and mortality in hospitalized patients. Diabetes Care. 2009; 33(4):739-41. PMC: 2845017. DOI: 10.2337/dc09-1748. View

20.

McMahon M, Rizza R . Nutrition support in hospitalized patients with diabetes mellitus. Mayo Clin Proc. 1996; 71(6):587-94. DOI: 10.4065/71.6.587. View