Comment gérer la nutrition artificielle chez un patient diabétique ?

Abstract

ARTICLE IN PRESS AbstractHyperglycaemia in patients receiving enteral or parenteral nutrition is a major problem due to its high prevalence and possible consequences in terms of morbidity and mortality. However, the management of diabetes/stress hyperglycaemia during artificial nutrition remains largely unknown, especially in non-critically ill patients. The indications and access routes for artificial nutrition are not different in patients with diabetes/stress diabetes than in non-diabetics. We do not recommend using enteral formulas designed for patients with diabetes. The glycaemic objective must be individualized. We recommend a preprandial blood glucose levels between 100 and 140 mg/dL (5.5 and 7.8 mmol/L) and postprandial levels between 140 and 180 mg/dL (7.8 and 10 mmol/L). A frequent monitoring of capillary glycaemias is mandatory. The best drug treatment for treating hyperglycaemia/diabetes is insulin and we recommend to adapt the theoretical insulin action to the nutrition infusion regimen. The management of these patients needs the help of a multidisciplinary experimented staff.