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.
Highlights
Intravenous (IV) infusion of nutrients, i.e. parenteral nutrition (PN), is a form of nutritional support indicated when the nutritional requirements cannot be met by oral intake or enteral nutrition (EN)
Consensus statements among organizations of health care professionals involved in inpatient diabetes care (e.g. American Diabetes Association, The Endocrine Society) as well as artificial nutrition (e.g. European Society of Clinical Nutrition and Metabolism [ESPEN], American Society for Parenteral and Enteral Nutrition [ASPEN]), recommend a blood glucose target of 7.8 to 10.0 mmol/L (140 to 180 mg/dL) for the majority of patients treated with insulin [20–23]
In post-operative patients with diabetes, the combination of PN with EN leads to reduced blood glucose concentrations, reduced insulin resistance, increased glucose-dependent insulinotropic peptide (GIP) and improved intestinal permeability compared to PN alone [26, 27]
Summary
Intravenous (IV) infusion of nutrients, i.e. parenteral nutrition (PN), is a form of nutritional support indicated when the nutritional requirements cannot be met by oral intake or enteral nutrition (EN). Diabetes is on the rise in patients who require nutritional support. Overweight and obesity are highly prevalent among patients with type 2 diabetes mellitus (T2DM), malnutrition and weight loss during hospitalization are harmful in these patients since they are accompanied by major muscle loss and associated with adverse. Hyperglycemia in patients receiving PN is associated with an increased risk of cardiac complications (OR 1.61), infection (OR 1.4), sepsis (OR 1.36), acute renal failure (1.47) and death (OR 1.77) [15]. Glucose is lost during hyperglycemia through glycosuria [renal threshold ~10 mmol/L (~180 mg/dL)], which may lead to energy loss and to deterioration of the nutritional status [16]. The insulin administration is crucial to control blood glucose, but a lack of insulin may increase muscle catabolism during acute illness. The aim of this review is to give an overview of the management of PN-associated hyperglycemia in inpatients with diabetes
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
