Variable Rate Intravenous Insulin Research Articles

A UK national survey of enteral feed use in people with diabetes 2022.

Enteral feeding is commonly used to manage a variety of medical conditions in hospitals. For people with diabetes this can present a specific challenge for glucose management. To address gaps in our understanding of modern enteral feeding outcomes and to help with the development of more specific guidance on maintaining glycaemic control, we conducted a national survey on the management of enteral feeding against the standards in the nationally adopted Joint British Diabetes Societies for Inpatient Care (JBDS) guidelines. A questionnaire was developed using the 2018 JBDS guideline as a template this questionnaire was sent out by email to all 220 UK specialist diabetes teams. Databases of Diabetes UK, the Association of British Diabetologists (ABCD) and the Diabetes Inpatient Specialist Nurse UK Group were used. Twenty-six hospitals responded, 11 had guidelines for the management of insulin with enteral feeding. There were three main feed regimens used: continuous 24-h feeding, a single feed with one break in 24 h, or multiple feeds in 24 h. There were five regimens in common use: premixed insulin, isophane insulin, analogue basal insulin, variable rate intravenous insulin or basal bolus insulin. Overall glucose control was poor for all regimens and combinations. Continuous feed showed better glucose control than a single feed with a break, mean (±SD) glucose 12.4 mmol/L (5.6) versus 15.1 mmol/L (6.9) p < 0.005, but no group showed optimal control. Managing diabetes control during enteral feeding remains a challenge. Our survey showed that glucose control during this treatment is suboptimal.

Inpatient management of patients with diabetes and chronic kidney disease undergoing elective surgery in a large nephrology centre

The objective of this study was to evaluate current practice in the management of glycaemia in patients with diabetes undergoing elective surgical procedures in a single renal unit. We performed an audit of the hospital records of 83 patients undergoing elective surgical procedures at a regional renal unit between January and March 2011. Of these patients 22 had diabetes: four with type 1 diabetes and 18 with type 2 diabetes. During their hospitalisation, glucose control was suboptimal with good diabetic days accounting for 52% of the hospital admission. There was over-reliance on variable rate intravenous insulin, which was prescribed in 59% of patients, of which the majority were deemed inappropriate. Prescription errors were more common when insulin was used, with 67% of prescription charts having at least one dose of insulin omitted or not signed. Oral agents were prescribed and administered accurately in 87% of patients. A hypoglycaemic event was experienced by 22% of patients. In conclusion, patients with diabetes and chronic kidney disease are at risk of suboptimal glycaemic management during hospitalisation for elective surgery. These findings have led to improved pre-operative planning, blood glucose management protocols and targeted education programmes.