Use of a Low-carbohydrate Enteral Nutrition Formula with Effective Inhibition of Hypoglycemia and Post-infusion Hyperglycemia in Non-diabetic Patients Fed via a Jejunostomy Tube

Abstract

Objective As direct jejunal feeding often causes great fluctuation in glucose levels, continuous or slow infusion is recommended for jejunal tube-fed patients. However, continuous feeding results in prolonged immobility and the loss of activities of daily living. We investigated whether or not intermittent feeding of a low-carbohydrate high-monounsaturated fatty acid (LC/HM) nutrient formula reduces glucose fluctuation in patients who have undergone jejunotomy. Methods Ten bed-ridden non-diabetic patients receiving enteral feeding via a jejunostomy tube were enrolled in this study. LC/HM formula and standard control formula were infused in cross-over order for each patient at a speed of 160 kcal/h. Blood glucose levels were monitored by a continuous glucose monitoring system during the investigation period. Results The mean and standard deviation of the glucose concentrations and mean amplitude of glucose excursion (MAGE) were markedly lower while receiving LC/HM formula than while receiving control standard formula (104 vs. 136 mg/dL, 18.1 vs. 58.1 mg/dL, 50.8 vs. 160 mg/dL, respectively). The post-infusion hyperglycemia [area under the curve (AUC) ＞140 mg/dL] and peak value of the glucose level were also significantly lower in patients fed LC/HM than the control (25.7 vs. 880 mg・h/dL and 153 vs. 272 mg/dL, respectively). Reactive hypoglycemia (AUC ＜70 mg/dL) was also significantly lower (0.63 vs. 16.7 mg・h/dL) and the minimum value of the glucose level higher (78.4 vs. 61.8 mg/dL) in patients fed LC/HM than the control. Conclusion The LC/HM formula is considered to markedly inhibit glycemic spikes and prevent rebound hypoglycemia in patients who receive enteral feeding after jejunostomy.

Prognostic outcomes after direct percutaneous endoscopic jejunostomy in elderly patients: comparison with percutaneous endoscopic gastrostomy

“…28 Slow or continuous infusion or use of low carbohydrate formulas are required for the prevention of glycemic fluctuation in jejunal feeding. 29,30 Regarding analysis of the causes of death after PEG, Johnston et al 31 reported that the most frequent cause was respiratory disease, followed by central nervous system and cardiovascular diseases among their patients who died within 30 days after PEG. Suzuki et al 32 reported that 59% of Japanese geriatric patients died due to pneumonia on a long-term analysis after PEG.…”

Mitigation of Rebound Hyperglycemia With Real-Time Continuous Glucose Monitoring Data and Predictive Alerts

“…Our choice of the glucose concentrations and time intervals for defining RH events differs from earlier definitions that were not based on CGM data 3 or did not require antecedent hypoglycemia. 3,5 We chose 180 mg/dL as the lower boundary for hyperglycemia to be consistent with consensus guidelines. 20,21 Separately, a recent analysis of discriminant ratios 22 proposed 180 mg/dL as the ideal threshold value for hyperglycemia.…”

“…RH has also been observed in patients without diabetes after resection of insulinomas 4 or after enteral feeding. 5 The use of continuous glucose monitoring (CGM) systems in diabetes management is increasing, and adoption of realtime CGM (rtCGM) systems is associated with sustainable improvements in hemoglobin A1c. 6,7 In adults with type 1 diabetes and impaired awareness of hypoglycemia, the HypoDE study 8 showed that access to rtCGM data was associated with significant reductions in the number of hypoglycemic events.…”

“…RH has also been observed in patients without diabetes after resection of insulinomas 4 or after enteral feeding. 5…”