Management of Hyperglycemia in Hospitalized Patients Receiving Parenteral Nutrition

Abstract

Almost half of inpatients on parenteral nutrition experience hyperglycemia, which increases the risk of complications and mortality. The blood glucose target for hospitalized patients on parenteral nutrition is 7.8 to 10.0 mmol/L (140 to 180 mg/dL). For patients with diabetes, the same parenteral nutrition formulae as for patients without diabetes can be used, as long as blood glucose levels can be adequately controlled using insulin. Insulin can be delivered via the subcutaneous or intravenous route or, alternatively, added to parenteral nutrition admixtures. Combining parenteral with enteral and oral nutrition can improve glycemic control in patients with sufficient endogenous insulin stores. Intravenous insulin infusion is the preferred route of insulin delivery in critical care as doses can be rapidly adjusted to altered requirements. For stable patients, insulin can be added directly to the parenteral nutrition bag. If parenteral nutrition is infused continuously over 24 hours, the subcutaneous injection of a long-acting insulin combined with correctional bolus insulin may be adequate. The aim of this review is to give an overview of the management of parenteral nutrition-associated hyperglycemia in inpatients with diabetes.

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“…Blood glucose levels should be maintained within 140 - 180 mg/dL for the general ICU population [ 71 ]. Blood glucose monitoring should align with the PN infusion schedule and the patient’s clinical status [ 76 ]. Careful consideration is necessary when administering subcutaneous insulin before planned PN interruptions [ 71 ].…”

Presentation, Treatment, and Complications of Acute Dehydration in Hyperemesis Gravidarum

“…In situations where enteral feeding is not possible or inadequate, parenteral nutrition becomes crucial as it involves administering nutrients. Close monitoring by a nutritionist or dietitian is imperative to maintain appropriate calorie and nutrient intake (23,24). Psychological support plays a pivotal role in HG management.…”

Behavior of Regular Insulin in a Parenteral Nutrition Admixture: Validation of an LC/MS-MS Assay and the In Vitro Evaluation of Insulin Glycation

“…Indeed, hyperglycemia is observed in 50% of patients receiving PN, and is known to be harmful in both nondiabetic and diabetic individuals [ 2 , 3 , 4 ]. Various insulin formulations and regimens can be administered [ 5 ]: subcutaneously administered long-acting insulin [ 6 , 7 , 8 , 9 , 10 , 11 ] (reportedly associated with a greater frequency of hypoglycemic events [ 11 ], particularly when PN infusion has to be suspended [ 9 ]) or intravenous short-acting insulin (either via a Y-site insulin infusion [ 8 , 12 , 13 ] or direct addition of regular insulin (R-insulin) or its rapid-acting analogs to the PN admixture [ 7 , 10 , 11 , 14 , 15 , 16 , 17 , 18 , 19 , 20 ]). The guidelines issued by the American Society for Parenteral and Enteral Nutrition (ASPEN) and the European Society for Clinical Nutrition and Metabolism (ESPEN) emphasize the need for stability and efficacy data prior to the co-infusion of drugs and PN [ 21 , 22 , 23 ].…”