[Artificial nutrition in hyperglycemia and diabetes mellitus in critically ill patients]

The need to strictly control glucose levels, even in nondiabetic patients, has recently emerged following the publication of the results that indicate the possibility of reducing the morbidity and mortality in critically ill patients. Since hyperglycemia is one of the most frequent metabolic impairments in these patients, insulin therapy is a necessity in most of the cases. In order to prevent hyperglycemia and its associated complications, nutritional support must be adjusted to the patient's requirements, avoiding hyponutrition. Whenever possible, nutrients supply should be done through the digestive route. Parenteral nutrition is more often accompanied by hyperglycemia and requires an increase in insulin dosage to control it. There are two types of enteral diets designed to help controlling hyperglycemic conditions: carbohydrates rich diets, and fat rich diets. In general terms, carbohydrates rich diets may be recommended in type 1 diabetic patients who are in a stable condition, and fat rich diets in type 2 diabetes and in stress hyperglycemia. In both cases, the use of low glycemic index carbohydrates is recommended. Protein intake should be adjusted to the patients' metabolic stress level. In diabetic patients with acute disease, an increase in antioxidants intake is recommended.