The addition of insulin to home parenteral nutrition for the control of hyperglycaemia: A case series

McCulloch, Adam; Bansiya, Vishakha; Woodward, J

doi:10.1016/j.clnesp.2018.11.014

Cited by 6 publications

(8 citation statements)

References 8 publications

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“…In terms of management of hyperglycemia, our HPN program typically recommends adding regular insulin directly into PN, which can prevent a discordance between insulin and PN administration that may arise when insulin (particularly long‐acting insulin) is provided subcutaneously and PN is held. A similar approach was highlighted in a recent case series observing patients receiving HPN for a period of 3–17 years and reporting good glycemic control and no significant episodes of hypoglycemia with insulin added directly to PN 55 . Evidence from inpatient trials also supports the approach of adding insulin to PN directly.…”

Section: Hyperglycemiamentioning

confidence: 72%

“…A similar approach was highlighted in a recent case series observing patients receiving HPN for a period of 3-17 years and reporting good glycemic control and no significant episodes of hypoglycemia with insulin added directly to PN. 55 Evidence from inpatient trials also supports the approach of adding insulin to PN directly. A recent trial in patients with type 2 diabetes randomized 81 patients to receiving 100% regular insulin in PN and 80 patients receiving 50% of their insulin needs in PN and 50% subcutaneously.…”

Section: Hyperglycemiamentioning

confidence: 95%

See 1 more Smart Citation

Management of long‐term home parenteral nutrition: Historical perspective, common complications, and patient education and training

Mundi

Elfadil

Hurt

et al. 2022

J Parenter Enteral Nutr

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Intestinal failure (IF) is a rare disease that requires ongoing intravenous supplementation to sustain growth and health. Advancements in parenteral nutrition (PN) and central venous access in the 1960s and 1970s transformed a life-limiting disease to a chronic one in which patients are able to administer hydration, electrolytes, micronutrients, and macronutrients in the comfort of their home. However, despite ongoing advancements in the field of home PN (HPN), complications-whether related to central venous catheters or PN itself-remain common and can be associated with significant morbidity and mortality. Central venous access can be associated with thrombosis, central line-associated bloodstream infection, or damage and can result in loss of access over time. PN can be associated with IF-associated liver disease or hyperglycemia. The key to preserving central venous access and quality of life and maintaining health for patients with chronic IF (CIF) is education focused on prevention and prompt management of CIF complications as they arise. This education typically takes place at the time of initiation of HPN, either in the hospital setting or in the patient's home. The present manuscript describes the historical progression of HPN, prevalence and characteristics of CIF, and an in-depth discussion of the most common catheter-related and PN-related complications and their management, along with a discussion of our education and training process.

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Section: Hyperglycemiamentioning

confidence: 72%

Section: Hyperglycemiamentioning

confidence: 95%

Management of long‐term home parenteral nutrition: Historical perspective, common complications, and patient education and training

Mundi

Elfadil

Hurt

et al. 2022

J Parenter Enteral Nutr

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“…In our case, massive small intestine resection resulted in short bowel syndrome as evidenced by a lack of postprandial hyperglycemia even in the absence of endogenous and bolus insulin. Therefore, life-long parenteral nutrition is necessary for a survival in short bowel syndrome (4)(5)(6)(7)(8). However, type 1 diabetes leads to life-threatening hyperglycemia unless insulin administration is appropriately matched with glucose infusion.…”

Section: Discussionmentioning

confidence: 99%

“…Short bowel syndrome due to massive resection of the intestine is common ( 4 - 6 ); however, short bowel syndrome complicated with type 1 diabetes is extremely rare ( 7 ). In our case, massive small intestine resection resulted in short bowel syndrome as evidenced by a lack of postprandial hyperglycemia even in the absence of endogenous and bolus insulin.…”

Section: Discussionmentioning

confidence: 99%

Glycemic Excursion and Insulin Action Revealed in a Rare Case of Type 1 Diabetes Complicated with Short Bowel Syndrome

et al. 2023

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We herein report a 52-year-old woman with a rare combination of short bowel syndrome due to massive resection of the small intestine and complete loss of endogenous insulin due to type 1 diabetes. To provide nutritional support, she was treated with total parenteral nutrition with co-administration of insulin, requiring careful matching of insulin and glucose levels. This case report provides insights on glycemic excursion and insulin action in type 1 diabetes, even when both insulin and glucose are administered directly into circulation, and the usual obstacles caused by subcutaneous injection of insulin and oral intake of nutrients are eliminated.

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“…Vorteile der Insulinapplikation in die PE sind weniger erforderliche subkutane Insulinkorrekturen unter der Infusionstherapie sowie ein insgesamt geringerer Insulinbedarf. Unter der kontinuierlichen Applikation stellt sich ein steady state zwischen Insulin und Glukoseinfusion ein, wodurch sich Blutzuckerspiegel unter Infusion mit deutlich geringeren Schwankungen ergeben [498,499] [499]. Somit stellt gerade in der häuslichen Versorgung das Zuspritzen eines Kurzzeitinsulins in die HPE ein effektives Regime zur adäquaten Kontrolle des Blutzuckerspiegels unter der Voraussetzung einer stabilen glykämischen Situation (vorhersehbarer Insulinbedarf, stabile Blutzuckerwerte) dar [498,499].…”

Section: Kommentarunclassified

S3-Leitlinie Heimenterale und heimparenterale Ernährung der Deutschen Gesellschaft für Ernährungsmedizin (DGEM)

Bischoff,

Arends,

Decker-Baumann

et al. 2024

Aktuelle Ernährungsmedizin

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ZusammenfassungMedizinische Ernährungstherapie, die enterale und parenterale Ernährung umfasst, ist ein wesentlicher Teil der Ernährungstherapie. Medizinische Ernährungstherapie beschränkt sich nicht auf die Krankenhausbehandlung, sondern kann effektiv und sicher auch zu Hause eingesetzt werden. Dadurch hat sich der Stellenwert der Medizinischen Ernährungstherapie deutlich erhöht und ist zu einem wichtigen Bestandteil der Therapie vieler chronischer Erkrankungen geworden. Für Menschen mit chronischem Darmversagen, z. B. wegen Kurzdarmsyndrom ist die Medizinische Ernährungstherapie sogar lebensrettend. In der Leitlinie wird die Evidenz für die Medizinische Ernährungstherapie in 161 Empfehlungen dargestellt. Die Leitlinie wendet sich in erster Linie an Ärzte, Ernährungsfachkräfte und Pflegekräfte, sie dient der Information für Pharmazeuten und anderes Fachpersonal, kann aber auch für den interessierten Laien hilfreich sein.

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The addition of insulin to home parenteral nutrition for the control of hyperglycaemia: A case series

Cited by 6 publications

References 8 publications

Management of long‐term home parenteral nutrition: Historical perspective, common complications, and patient education and training

Management of long‐term home parenteral nutrition: Historical perspective, common complications, and patient education and training

Glycemic Excursion and Insulin Action Revealed in a Rare Case of Type 1 Diabetes Complicated with Short Bowel Syndrome

S3-Leitlinie Heimenterale und heimparenterale Ernährung der Deutschen Gesellschaft für Ernährungsmedizin (DGEM)

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