Increased hypoglycemia associated with renal failure during continuous intravenous insulin infusion and specialized nutritional support

Dickerson, Roland N.; Hamilton, Leslie A.; Connor, Kathryn; Maish, George O.; Croce, Martin A.; Minard, Gayle; Brown, Rex O.

doi:10.1016/j.nut.2010.08.009

Cited by 29 publications

(33 citation statements)

References 63 publications

(93 reference statements)

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“…Patients with AKI are at particular risk [197]. On the other hand, a causal relationship between a short-lasting iatrogenic hypoglycaemia in the monitored setting of an ICU and outcome remains controversial [198–200].…”

Section: Hormonal Manipulationmentioning

confidence: 99%

Prevention of acute kidney injury and protection of renal function in the intensive care unit: update 2017

et al. 2017

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BackgroundAcute kidney injury (AKI) in the intensive care unit is associated with significant mortality and morbidity.ObjectivesTo determine and update previous recommendations for the prevention of AKI, specifically the role of fluids, diuretics, inotropes, vasopressors/vasodilators, hormonal and nutritional interventions, sedatives, statins, remote ischaemic preconditioning and care bundles.MethodA systematic search of the literature was performed for studies published between 1966 and March 2017 using these potential protective strategies in adult patients at risk of AKI. The following clinical conditions were considered: major surgery, critical illness, sepsis, shock, exposure to potentially nephrotoxic drugs and radiocontrast. Clinical endpoints included incidence or grade of AKI, the need for renal replacement therapy and mortality. Studies were graded according to the international GRADE system.ResultsWe formulated 12 recommendations, 13 suggestions and seven best practice statements. The few strong recommendations with high-level evidence are mostly against the intervention in question (starches, low-dose dopamine, statins in cardiac surgery). Strong recommendations with lower-level evidence include controlled fluid resuscitation with crystalloids, avoiding fluid overload, titration of norepinephrine to a target MAP of 65–70 mmHg (unless chronic hypertension) and not using diuretics or levosimendan for kidney protection solely.ConclusionThe results of recent randomised controlled trials have allowed the formulation of new recommendations and/or increase the strength of previous recommendations. On the other hand, in many domains the available evidence remains insufficient, resulting from the limited quality of the clinical trials and the poor reporting of kidney outcomes.Electronic supplementary materialThe online version of this article (doi:10.1007/s00134-017-4832-y) contains supplementary material, which is available to authorized users.

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Section: Hormonal Manipulationmentioning

confidence: 99%

Prevention of acute kidney injury and protection of renal function in the intensive care unit: update 2017

et al. 2017

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“…This increases the risk of hypoglycaemia and severe hypoglycaemia by approximately twofold compared with patients without renal impairment 20 . Hypoglycaemic episodes are a significant risk for patients with chronic kidney disease so that even episodes of relatively mild hypoglycaemia can significantly increase shortterm mortality compared with non-hypoglycaemic patients [20][21][22] .…”

Section: Renal Impairmentmentioning

confidence: 99%

Increasing awareness of hypoglycaemia in patients with Type 2 diabetes treated with oral agents

Barnett

Brice

Hanif

et al. 2013

Current Medical Research and Opinion

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Hypoglycaemia is the most common acute complication of type 2 diabetes and can limit therapeutic efforts to improve glycaemic control in order to protect against long-term complications. It is a potential side effect of the drugs used to treat diabetes, specifically exogenous insulin or insulin secretagogues. As many people are prescribed these agents, hypoglycaemia is frequent in clinical practice, although patients commonly do not inform their healthcare professional of the problems spontaneously. The impact of hypoglycaemia on the patient and to the healthcare system is significant through reduced treatment satisfaction and adherence, reduced quality of life and serious health consequences. This has financial implications and costs for the patient, the public and the economy at large. The single most important risk factor for hypoglycaemia is previous hypoglycaemia. Prevention depends on appropriate education regarding diabetes management and selfcare, self-monitoring of blood glucose, awareness of factors that may precipitate hypoglycaemia, and an individualized approach to therapy and glycaemic control targets. The purpose of this review is to increase understanding of the impact and consequences of hypoglycaemia, in particular that associated with sulphonylurea therapy, and to highlight areas requiring more attention in order to improve the overall management of people with type 2 diabetes.

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“…Several factors have been associated with increased risk of hypoglycemia, including time on IIT [20] , need for dialysis, history of diabetes, sepsis, need for vasopressors, and BMI [21–23] . Although the landmark study advocating IIT by Van den Berghe et al provided a calculated glucose infusion within the first 24 hours and provided either total parenteral nutrition (TPN) or enteral nutrition (EN) by the second day [9] , little emphasis has been given to the role of nutritional provision in improving outcomes in patients treated with IIT.…”

Section: Introductionmentioning

confidence: 99%

Provision of Balanced Nutrition Protects Against Hypoglycemia in the Critically Ill Surgical Patient

Kauffmann¹,

Hayes

Jenkins³

et al. 2011

J Parenter Enteral Nutr

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Background Intensive insulin therapy lowers blood glucose and improves outcomes, but increases the risk of hypoglycemia. Typically, insulin protocols require a dextrose solution to prevent hypoglycemia. We hypothesized that the provision of balanced nutrition (enteral or parenteral nutrition) would be more protective against hypoglycemia (≤50 mg/dL) than carbohydrate alone. Methods A retrospective analysis was performed of patients treated with intensive insulin therapy and surviving ≥ 24 hours. The computer-based insulin protocol requires infusion of D10W at 30 ml/hr if enteral or parenteral nutrition is not provided. Nutritional provision was assessed in two -hour increments, comparing periods of blood glucose control with and without balanced nutrition. The risk of hypoglycemia for each BG measurement was estimated by multivariable regression. Results 66,592 glucose measurements were collected on 1392 patients. Hypoglycemia occurred in 11.1% patients and 0.32% of glucose measurements. Hypoglycemic events occurred in 5.8/1000 glucose tests after two hours without balanced nutrition compared to 2.2/1000 tests when balanced nutrition was given in the preceding two hours. In multivariable regression models, balanced nutrition was the strongest protective factor against hypoglycemia. Patients who did not receive balanced nutrition in the preceding two hours had a 3X increase in odds of a hypoglycemic event at their next glucose check (OR 3.6, p<0.001). Providing carbohydrate alone was not protective. Conclusions Balanced nutrition is associated with reduced risk of hypoglycemia. These results suggest that balanced nutrition should be given when insulin therapy is initiated. Future studies should evaluate the efficacy of enteral nutrition versus total parenteral nutrition in preventing hypoglycemia, and associations between balanced nutrition and mortality.

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Increased hypoglycemia associated with renal failure during continuous intravenous insulin infusion and specialized nutritional support

Abstract: Despite receiving a modified RHI infusion, critically ill trauma patients with renal failure are at greater risk for developing hypoglycemia and have more glycemic variability than patients without renal failure.

Cited by 29 publications

References 63 publications

Prevention of acute kidney injury and protection of renal function in the intensive care unit: update 2017

Prevention of acute kidney injury and protection of renal function in the intensive care unit: update 2017

Increasing awareness of hypoglycaemia in patients with Type 2 diabetes treated with oral agents

Provision of Balanced Nutrition Protects Against Hypoglycemia in the Critically Ill Surgical Patient

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