Predictors of Insulin Requirements Among Hospitalized Adults Receiving Parenteral Nutrition

Abstract

A total of 1388 patients were started on PN. After adjusting for potential confounders, strong associations existed between PN insulin requirements and diabetes mellitus (DM) diagnosis (OR, 8.90; 95% CI, 4.98-15.90, P < .001), overweight/obese status (body mass index ≥25.0 kg/m(2)) (OR, 2.12; 95% CI, 1.04-4.30, P = .04), intensive care unit (ICU) admission (OR, 1.79; 95% CI, 1.03-3.11, P = .04), blood glucose (BG) on day of PN start >120 mg/dL (OR, 2.32; 95% CI, 1.32-4.05, P = .003), mean BG >180 mg/dL while receiving PN (OR, 6.10; 95% CI, 2.18-17.04, P = .001), and hemoglobin A1c (A1c) ≥5.7% (OR, 3.18; 95% CI, 1.84-5.50, P < .001). Among variables available at PN initiation, DM diagnosis (P < .001), A1c ≥5.7% (P < .001), BG >120 mg/dL on PN start day (P < .001), and ICU admission (P < .001) predicted the need for PN insulin.

Prevalence and Risk Factors of Total Parenteral Nutrition Induced Hyperglycemia at a Single Institution: Retrospective Study

“…This result is in accord with many previous studies indicating that duration of TPN treatment was correlated positively with blood glucose levels among patients on TPN. 6,16,21 However, this outcome is contrary to that of Lee et al 11 and Olveira et al 22 who did not find a significant correlation between hyperglycemia and duration of TPN.…”

“…3 Hyperglycemia, defined as blood glucose value greater than 180 mg/dL or 10 mM per the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) guidelines, is one of the metabolic complications that is common among adult patients receiving TPN treatment 5,6 with an approximate incidence rate of 17%-67%. [7][8][9][10][11][12] Hyperglycemia and its metabolic consequences can lead to adverse outcomes.…”

Post-Transplant Diabetes Mellitus: Causes, Treatment, and Impact on Outcomes

“…TPN can increase insulin requirements that can be covered with a separate iv insulin drip, with or without the addition of insulin to the TPN solution. Once stable, iv insulin can be transitioned to long-acting insulin with correction insulin every 4 to 6 hours as needed, although there is safety in keeping some of the insulin requirements in the TPN to prevent hypoglycemia if the TPN were discontinued unexpectedly (172). However, it is essential to anticipate and change the insulin therapy, whether iv or sc, with noted interval improvement in insulin resistance, planned transition off TPN, or planned taper of immunosuppression.…”

Management of hospitalized type 2 diabetes mellitus patients

“…One study shows the relationship between requirements of insulin in T2DM patients with parenteral nutrition and different predictors, with a heavy relationship with ICU admission, overweight or obesity, and blood glucose control > 120 mg/dL on day, that parenteral nutrition initiate or a mean > of 180 mg/dL during receiving the nutritional support. [40] There are not many articles that study the administration of glargine in patients with parenteral nutrition and these studies have different results about glycemic control. Moreover, if parenteral nutrition is stopped, the long action of glargine can produce hypoglycemia and it is important to use the adequate mechanism to avoid this.…”