Insulin pump therapy improves blood glucose control during hyperalimentation.

Area of Science:

• Endocrinology
• Metabolic Disorders
• Critical Care Medicine

Background:

• Patients with severe sepsis or burns often require intensive nutritional support via enteral feeding.
• High caloric and carbohydrate loads during enteral hyperalimentation can lead to significant hyperglycemia and insulin resistance.
• Maintaining optimal glycemic control is crucial for improving outcomes in critically ill patients.

Purpose of the Study:

• To assess the feasibility and efficacy of basal continuous subcutaneous insulin infusion (CSII) in patients receiving enteral hyperalimentation.
• To evaluate blood glucose control during CSII in patients with postoperative sepsis or extensive burns.
• To determine if CSII can improve metabolic response to high-dose enteral nutrition.

Main Methods:

• A feasibility study involving four patients with postoperative sepsis or extensive burns.
• Patients received continuous enteral hyperalimentation (2,500–3,000 kcal/day) with high carbohydrate content.
• Basal continuous subcutaneous insulin infusion (CSII) was administered for a mean duration of 16.8 days.

Main Results:

• Mean capillary blood glucose levels decreased significantly from 322 +/- 52 mg/dL pre-CSII to 195 +/- 33 mg/dL during CSII.
• Only 1.3% of blood glucose readings were below 60 mg/dL, indicating a low risk of hypoglycemia.
• The majority of glucose values (61.6%) fell within the target range of 61–200 mg/dL.

Conclusions:

• Basal CSII is a safe and effective method for improving blood glucose control in patients on enteral hyperalimentation.
• CSII can manage hyperglycemia associated with high carbohydrate intake and insulin resistance in critically ill patients.
• This approach offers an alternative to intravenous insulin, enhancing metabolic management without requiring central venous access.