Evaluation of NPH Insulin Dosing Interval for Critically Ill Hyperglycemic Trauma Patients During Continuous Enteral...

The aim of this study was to retrospectively evaluate the results of administering subcutaneous neutral protamine Hagedorn (NPH) insulin every 8 h (NPH-8) versus every 12 h (NPH-12) in critically ill, hyperglycemic trauma patients who required continuous enteral nutrition (EN).

Both groups of patients were given concurrent sliding scale regular human insulin (SSI) with NPH therapy. The evaluation of glycemic control continued for 7 days.

A total of 15 patients were given NPH every 8 h (NPH-8), and 19 were given NPH every 12 h (NPH-12). Carbohydrate intake was similar between groups (115 ± 35 vs. 108 ± 37 g/d; p = 0.584). There was no significant difference in average blood glucose (BG) concentration (168 ± 18 vs. 166 ± 17 mg/dL; p = 0.803) or time within a BG target range of 70 to 149 mg/dL (7.5 ± 4.7 vs. 8.1 ± 5.0 h/d; p = 0.678) or 70 to 179 mg/dL (14.5 ± 5.0 vs. 16 ± 5.6 h/d; p = 0.419) or the incidence of Level 1 hypoglycemia (2 patients in each group; p = 1.00) or Level 2 hypoglycemia (1 patient vs. 0 patients, p = 0.441) between the NPH-8 and NPH-12 groups, respectively. However, the NPH-8 group required twice as much total (NPH + SSI) insulin (115 ± 52 vs. 58 ± 33 units/d; p = 0.004).

These preliminary data suggest no significant difference between the administration of NPH-8 and NPH-12 based on glycemic control metrics in critically ill hyperglycemic trauma patients given EN. However, these results may be confounded by a selection bias as to who received NPH-8 vs. NPH-12. Further research is required.