Hypoglycemia with Insulin and Parenteral Nutrition

Abstract

Hyperglycemia is a common occurrence in hospitalized patients and may be related to stress, preexisting diabetes, or the use of intravenous (IV) dextrose. Achievement of blood glucose (BG) control is essential in order to prevent adverse outcomes associated with hyperglycemia. However, glucose control is challenging and may be associated with the risk of hypoglycemia. The use of parenteral nutrition (PN) further exacerbates hyperglycemia in the hospitalized, stressed patient. Hypoglycemia may be a consequence of overtreatment of hyperglycemia with the use of insulin and concomitant PN. The nutrition support clinician must pay careful attention to the PN patient’s medical condition, medication administration, and laboratory values. Serum BG should be maintained within a range of 140–180 mg/dL and dextrose infusion should be limited to 4–7 mg/kg/min. Conditions that predispose a patient to hypoglycemia should be noted, which include advanced age, changes in nutritional status, renal failure, liver disease, and other concurrent illnesses. In addition, characteristics of a patient receiving PN and insulin therapy exist which increase the likelihood of the observance of a hypoglycemic event and should be monitored closely. These characteristics include patients located in the intensive care unit (ICU), those on an insulin drip, patients with previous history of diabetes, and those requiring long-term PN. The use of an evidence-based insulin protocol for patients on PN is crucial to minimize hypoglycemia.