Insulin pump therapy improves blood glucose control during hyperalimentation

The present study investigated the feasibility of basal continuous subcutaneous insulin infusion (CSII) in four patients with postoperative sepsis or extensive burns during continuous enteral hyperalimentation with 2,500 to 3,000 calories/day, containing approximately 390 g of simple carbohydrates. The mean duration of CSII treatment was 16.8 days (range, seven to 32 days). The mean capillary blood glucose level fell from 322 +/- 52 mg/dL during pre-CSII therapy to 195 +/- 33 mg/dL during CSII therapy. Only 1.3% of 1,254 capillary blood glucose values were less than 60 mg/dL. Most values (61.6%) were between 61 and 200 mg/dL. The mean insulin infusion rate was 2.5 +/- 1.5 units/hr. These preliminary observations suggest that basal infusion CSII is a safe and effective means of improving blood glucose control in patients receiving enteral hyperalimentation despite the high glucose intake and presence of insulin resistance. Thus, CSII therapy can enhance the metabolic response to hyperalimentation without requiring an intravenous access route.