Acute nutrition management in insulin-dependent diabetes: presentation of an index case

Diabetic patients unable to ingest nutrients orally but who have functioning gastrointestinal tracts should be nutritionally supported via enteral feeding. Provision of enteral nutrition can be problematic in terms of glycemic control. Diabetes compounded with kidney failure further complicates calorie delivery and distribution. Enteral-nutrition formulas should be carefully selected with attention to macronutrient profile, specific carbohydrate constituents, and presence or absence of dietary fiber. Modular components can be added to standard enteral feedings to alter calorie distribution while enhancing calorie provision. Selecting the method of insulin infusion (i.e., intermittent subcutaneous insulin therapy versus continuous intravenous or continuous subcutaneous infusion) for maximizing glucose control is an important step in the acute nutrition management of insulin-dependent diabetic patients. Attention to nutrition indices, fingersticks, and parameters of enteral-feeding intolerance is of utmost importance. The transition from enteral to oral nutrition will depend on adequacy of oral intake as determined by calorie counts.