Hypoglycemia in noncritically ill patients receiving total parenteral nutrition: A multicenter study.

Olveira, Gabriel; Tapia, María José; Ocón, Julia; Cabrejas-Gómez, Carmen; Ballesteros-Pomar, María D.; Vidal-Casariego, Alfonso; Arraiza-Irigoyen, Carmen; Olivares, Josefina; Conde-García, María C.; García-Manzanares, Álvaro; Botella-Romero, Francisco; Quílez-Toboso, Rosa P.; Matía, Pilar; Rubio, Miguel A.; Chicharro, L.; Burgos, R.; Pujante, Pedro; Ferrer, Mercedes; Zugasti, Ana; Petrina, E.; Manjón, Laura; Diéguez, Marta; Carrera, María; Vila-Bundo, Anna; Urgelés, Juan Ramón; Aragón-Valera, Carmen; Sánchez-Vilar, Olga; Bretón, Irene; García-Peris, Pilar; Muñoz-Garach, Araceli; Márquez, Efren; Olmo, Dolores del; Pereira, José; Tous, María C.

doi:10.1016/j.nut.2014.04.023

Cited by 16 publications

(11 citation statements)

References 28 publications

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“…The prevalence of hypoglycemia in patients receiving PN is not well known and has been related to an increase in complications and mortality [ 29 ]. The percentage ranges from a low of around 4% up to 40% [ 30 ]. In our report, 22.5% of patients experienced BG levels < 70 mg/dl and 7.5% < 40 mg/dl.…”

Section: Discussionmentioning

confidence: 99%

Differences in Glycemic Control in Diabetic and Non-diabetic Patients with Parenteral Nutrition Using a Basal plus Correction Insulin Regimen: An Observational, Retrospective Study

et al. 2018

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IntroductionHyperglycemia is a frequent complication of parenteral nutrition (PN) in patients both with and without diabetes mellitis (DM). The aim of this study was to evaluate the quality of glucose control achieved with basal plus-correction insulin in surgical patients with and without a history of DM receiving PN.MethodsRetrospective evaluation of a protocol applied during the period of January 2013–December 2015. The insulin dose was started at 0.4 and 0.3 IU/kg/day in patients with previous DM and without a history of DM, respectively, and the target blood glucose (BG) was < 180 mg/dl. Mean BG levels, insulin total daily dose (TDD) and hypoglycemic (< 70 mg/dl) events on different days of PN were also evaluated.ResultsForty-one patients with previous type 2 DM and 39 without DM were evaluated. Glycemic control in both groups was as follows: during the first 48 h (230.4 ± 67 vs. 189.4 ± 38 mg/dl, p = 0.002); at the midpoint (224.6 ± 58 vs. 181.3 ± 27 mg/dl, p = 0.003); 48 h before ending TPN (196.4 ± 43 vs. 169.8 ± 40 mg/dl, p = 0.004). Insulin TDD was 0.5 ± 0.3 U/kg/day in patients with DM and 0.37 ± 0.3 units/kg/day in those without DM (p < 0.05). A total of 18 patients experienced hypoglycemic events, without differences between the groups.ConclusionA basal-correction insulin regimen is an alternative method for managing hyperglycemia in non-critically ill surgical patients on PN.

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Section: Discussionmentioning

confidence: 99%

Differences in Glycemic Control in Diabetic and Non-diabetic Patients with Parenteral Nutrition Using a Basal plus Correction Insulin Regimen: An Observational, Retrospective Study

et al. 2018

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“…The inclusion of insulin in the PN was not found to have a significant effect on hypoglycemia after adjusting for body mass index, history of diabetes, days receiving PN, intensive treatment unit admission, and method of insulin dose calculation. The study by Olveira and colleagues prospectively analyzed the occurrence of hypoglycemia in 605 patients receiving PN across 19 Spanish hospitals. Of these 605 patients, 433 (71.6%) received insulin at some time during their PN infusion, with 35.8% of these receiving insulin added into PN.…”

Section: Resultsmentioning

confidence: 99%

“…Various single and combination approaches to management of PN‐related hyperglycemia have been reported, including intravenous insulin infusions, subcutaneous insulin administration, and direct addition of short‐acting insulin to PN . Of these, direct addition of short‐acting insulin to the PN mixture offers certain advantages.…”

mentioning

confidence: 99%

“…12 Various single and combination approaches to management of PN-related hyperglycemia have been reported, including intravenous insulin infusions, 2,9,13 subcutaneous insulin administration, and direct addition of short-acting insulin to PN. [14][15][16] Of these, direct addition of short-acting insulin to the PN mixture offers certain advantages. Expert opinion suggests that by consolidating the insulin dosage within the PN formula, a steady supply of insulin with the formula provides a smoother glycemic profile without increased risk of hypoglycemia by reducing discordance between insulin dosing and PN administration.…”

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confidence: 99%

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Addition of Insulin to Parenteral Nutrition for Control of Hyperglycemia

McCulloch

Bansiya

Woodward

2017

J Parenter Enteral Nutr

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Administration of parenteral nutrition (PN) may result in hyperglycemia in patients with preexisting diabetes or disease-related insulin resistance, and it can be associated with increased rates of complications. Treatment requires insulin therapy. Insulin can be administered subcutaneously, intravenously via a variable rate sliding scale, or by adding it directly to the PN. The last method is a potentially attractive technique for a number of reasons-it could deliver the insulin intravenously at a steady rate alongside carbohydrates, and in malnourished patients with little subcutaneous tissue, it may prevent the need for frequent insulin injections. Despite such potential advantages, the addition of insulin to PN remains controversial, largely with respect to the bioavailability of insulin in PN and resultant concerns of the risk of hypoglycemia. There is a paucity of long-term quality controlled studies to address this question. The available literature suggests that, at least in the short term, insulin addition to PN can achieve reasonable glycemic control with low rates of hypoglycemia, and the technique compares favorably with the use of long-acting insulin preparations. This literature review finds a wide range of values reported for insulin availability via PN, ranging from 44% to 95% depending on the type of PN container material used and the presence of added vitamins and trace elements. Few studies looking at glycemic control among patients receiving home PN were found, and larger prospective trials are needed to assess the efficacy and safety of this technique in this patient group.

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“…59 Patients at higher risk for rebound hypoglycemia are those with diabetes mellitus, treatment with IV insulin, and lower BMI. 64 Strategies for reducing this rebound hypoglycemia include gradual taper of PN infusion rate over 1-2 hours before discontinuation and establishing oral diet or enteral nutrition (EN) tolerance prior to PN discontinuation. 65,66 EFAD Essential fatty acids, or those that cannot be synthesized by the body, include linoleic acid (an ω-6 fatty acid) and α-linolenic acid (an ω-3 fatty acid).…”

Section: Hyperglycemiamentioning

confidence: 99%

Parenteral Nutrition Basics for the Clinician Caring for the Adult Patient

2016

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Parenteral nutrition (PN) is a life-sustaining therapy providing nutrients to individuals with impaired intestinal tract function and enteral access challenges. It is one of the most complex prescriptions written routinely in the hospital and home care settings. This article is to aid the nutrition support clinician in the safe provision of PN, including selecting appropriate patients for PN, vascular access, development of a PN admixture, appropriate therapy monitoring, recognition of preparation options, and awareness of preparation and stability concerns.

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Hypoglycemia in noncritically ill patients receiving total parenteral nutrition: A multicenter study.

Cited by 16 publications

References 28 publications

Differences in Glycemic Control in Diabetic and Non-diabetic Patients with Parenteral Nutrition Using a Basal plus Correction Insulin Regimen: An Observational, Retrospective Study

Differences in Glycemic Control in Diabetic and Non-diabetic Patients with Parenteral Nutrition Using a Basal plus Correction Insulin Regimen: An Observational, Retrospective Study

Addition of Insulin to Parenteral Nutrition for Control of Hyperglycemia

Parenteral Nutrition Basics for the Clinician Caring for the Adult Patient

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