Glycaemic control during enteral tube feeding in patients with diabetes who have had a stroke: a twice‐daily insulin regimen

Abstract

AbstractUncontrolled hyperglycaemia has been a problem in patients with diabetes mellitus who have had a stroke and require enteral tube feeding in our hospital. There is a sustained glucose rise as opposed to the postprandial peaks of normal eating. In the absence of national guidelines, we tailored an insulin regimen for our inpatients. In this observational study we evaluated the effectiveness of this regimen for glycaemic control in these patients.Inpatients with diabetes receiving enteral feeding were given insulin twice daily. The initial dose was calculated from estimated carbohydrate‐to‐insulin ratio, feed carbohydrate concentration, infusion rate and duration, and adjusted according to capillary glucose (target range: 6–12mmol/L).Twenty‐four patients required enteral feeding; average age 72 years and weight 73.8kg. The median (range) feed carbohydrate concentration was 12.3(12.3–20.1)g/100ml; the final feed infusion rate 75(50–100)ml/hr; feed duration 20(10–24)hours/day; and carbohydrate‐to‐insulin ratio 10(6–10). Initial insulin doses ranged from 12–32units/day. Target capillary glucose range was achieved in 17 patients. Of the seven patients who did not achieve the target range, four pulled out their feeding tubes too early, one had hyperosmolar state, one died of aspiration pneumonia and one had a very complex feeding regimen. There were no hypoglycaemic events.This study has confirmed that a simple twice‐daily insulin regimen for patients with diabetes mellitus who require enteral tube feeding is safe and effective for most patients. The importance of frequent blood glucose monitoring in these patients cannot be over‐emphasised. Copyright © 2012 John Wiley & Sons.