Skip to main content
SpringerLink
Log in

Diabetes and Parenteral Nutrition

  • Chapter
  • First Online:
Diabetes Management in Hospitalized Patients

Part of the book series: Contemporary Endocrinology ((COE))

  • 254 Accesses

Abstract

Use of parenteral nutrition (PN) serves as an option for provision of macro- and micronutrients in patients with a nonfunctional gastrointestinal tract. Treatment with PN contributes to clinical improvement in appropriate patients; however, metabolic effects and complications may develop. Common complications include line infections, liver disease as both cholestasis and hepatosteatosis, hypertriglyceridemia, and hyperglycemia. The risk for each of these complications is increased in patients with either type 1 or type 2 diabetes mellitus. Risk reduction and treatment of complications may be attained through adjustment of the PN formula. Reduction of dextrose content, use of a fish oil-based lipid formulation, appropriate micronutrient supplementation, and coordinated administration of insulin can address the risks of PN administration, especially among patients with diabetes mellitus.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 169.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 219.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Ayers P, Adams S, Boullata J, et al. A.S.P.E.N. Parenteral nutrition safety consensus recommendations. JPEN J Parenter Enteral Nutr. 2014;38(3):296–333.

    Article  PubMed  Google Scholar 

  2. Flombaum CD, Berner YN. TPN-induced catch-up of growth in a 22-y-old male with radiation enteritis. Am J Clin Nutr. 1989;50(6):1341–7.

    Article  CAS  PubMed  Google Scholar 

  3. Lappas BM, Patel D, Kumpf V, Adams DW, Seidner DL. Parenteral nutrition: indications, access, and complications. Gastroenterol Clin N Am. 2018;47(1):39–59.

    Article  Google Scholar 

  4. Boullata JI, Gilbert K, Sacks G, et al. A.S.P.E.N. Clinical guidelines: parenteral nutrition ordering, order review, compounding, labeling, and dispensing. JPEN J Parenter Enteral Nutr. 2014;38(3):334–77.

    Article  PubMed  Google Scholar 

  5. Cuerda C, Pironi L, Arends J, et al. ESPEN practical guideline: clinical nutrition in chronic intestinal failure. Clin Nutr. 2021;40(9):5196–220.

    Article  PubMed  Google Scholar 

  6. Via MA, Mechanick JI. Inpatient enteral and parenteral [corrected] nutrition for patients with diabetes. Curr Diab Rep. 2011;11(2):99–105.

    Article  CAS  PubMed  Google Scholar 

  7. Veterans Affairs Total Parenteral Nutrition Cooperative Study G. Perioperative total parenteral nutrition in surgical patients. N Engl J Med. 1991;325(8):525–32.

    Article  Google Scholar 

  8. Woodcock NP, Zeigler D, Palmer MD, Buckley P, Mitchell CJ, MacFie J. Enteral versus parenteral nutrition: a pragmatic study. Nutrition. 2001;17(1):1–12.

    Article  CAS  PubMed  Google Scholar 

  9. McClave SA, Taylor BE, Martindale RG, et al. Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.). JPEN J Parenter Enteral Nutr. 2016;40(2):159–211.

    Article  CAS  PubMed  Google Scholar 

  10. McMahon MM, Nystrom E, Braunschweig C, et al. A.S.P.E.N. Clinical guidelines: nutrition support of adult patients with hyperglycemia. JPEN J Parenter Enteral Nutr. 2013;37(1):23–36.

    Article  CAS  PubMed  Google Scholar 

  11. Ko JK, Lee YK, Na JC, Kim DY, Kim YR. A retrospective analysis evaluating the outcome of parenteral nutrition in the treatment of anorexia nervosa in Korea. J Clin Med. 2020; 9(11).

    Google Scholar 

  12. Via MA, Mechanick JI. In: Berger M, editor. Critical care nutrition therapy for non-nutritionists. Chronic critical illness: Springer; 2018. p. 149–60.

    Chapter  Google Scholar 

  13. Casaer MP, Mesotten D, Hermans G, et al. Early versus late parenteral nutrition in critically ill adults. N Engl J Med. 2011;365(6):506–17.

    Article  CAS  PubMed  Google Scholar 

  14. Compher C, Bingham AL, McCall M, et al. Guidelines for the provision of nutrition support therapy in the adult critically ill patient: the American Society for Parenteral and Enteral Nutrition. JPEN J Parenter Enteral Nutr. 2022;46(1):12–41.

    Article  CAS  PubMed  Google Scholar 

  15. Ziegler TR. Parenteral nutrition in the critically ill patient. N Engl J Med. 2009;361(11):1088–97.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Magill SS, Edwards JR, Bamberg W, et al. Multistate point-prevalence survey of health care-associated infections. N Engl J Med. 2014;370(13):1198–208.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Advani S, Reich NG, Sengupta A, Gosey L, Milstone AM. Central line-associated bloodstream infection in hospitalized children with peripherally inserted central venous catheters: extending risk analyses outside the intensive care unit. Clin Infect Dis. 2011;52(9):1108–15.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Dyson JK, Thompson N, Northern Nutrition N. Adult parenteral nutrition in the north of England: a region-wide audit. BMJ Open. 2017;7(1):e012663.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Fonseca G, Burgermaster M, Larson E, Seres DS. The relationship between parenteral nutrition and central line-associated bloodstream infections: 2009-2014. JPEN J Parenter Enteral Nutr. 2018;42(1):171–5.

    Article  PubMed  Google Scholar 

  20. Roszali MA, Zakaria AN, Mohd Tahir NA. Parenteral nutrition-associated hyperglycemia: prevalence, predictors and management. Clin Nutr ESPEN. 2021;41:275–80.

    Article  PubMed  Google Scholar 

  21. Balla KC, Rao SP, Arul C, et al. Decreasing central line-associated bloodstream infections through quality improvement initiative. Indian Pediatr. 2018;55(9):753–6.

    Article  PubMed  Google Scholar 

  22. Pironi L, Paganelli F, Labate AM, et al. Safety and efficacy of home parenteral nutrition for chronic intestinal failure: a 16-year experience at a single Centre. Dig Liver Dis. 2003;35(5):314–24.

    Article  CAS  PubMed  Google Scholar 

  23. Klein S, Nealon WH. Hepatobiliary abnormalities associated with total parenteral nutrition. Semin Liver Dis. 1988;8(3):237–46.

    Article  CAS  PubMed  Google Scholar 

  24. Lucchinetti E, Lou PH, Wawrzyniak P, et al. Novel strategies to prevent Total parenteral nutrition-induced gut and liver inflammation, and adverse metabolic outcomes. Mol Nutr Food Res. 2021;65(5):e1901270.

    Article  PubMed  Google Scholar 

  25. Jall S, Sachs S, Clemmensen C, et al. Monomeric GLP-1/GIP/glucagon triagonism corrects obesity, hepatosteatosis, and dyslipidemia in female mice. Mol Metab. 2017;6(5):440–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Maitiabula G, Tian F, Wang P, et al. Liver PP2A-Calpha protects from parenteral nutrition-associated hepatic steatosis. Cell Mol Gastroenterol Hepatol. 2022;14(3):669–92.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Guthrie G. Parenteral nutrition associated hepatic steatosis and NAFLD intersect at AMPK. Cell Mol Gastroenterol Hepatol. 2022;14(3):724–5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Fell GL, Anez-Bustillos L, Dao DT, et al. Alpha-tocopherol in intravenous lipid emulsions imparts hepatic protection in a murine model of hepatosteatosis induced by the enteral administration of a parenteral nutrition solution. PLoS One. 2019;14(7):e0217155.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Fell GL, Cho BS, Dao DT, et al. Fish oil protects the liver from parenteral nutrition-induced injury via GPR120-mediated PPARgamma signaling. Prostaglandins Leukot Essent Fatty Acids. 2019;143:8–14.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Nakamoto K, Shimada K, Harada S, Morimoto Y, Hirasawa A, Tokuyama S. DHA supplementation prevent the progression of NASH via GPR120 signaling. Eur J Pharmacol. 2018;820:31–8.

    Article  CAS  PubMed  Google Scholar 

  31. Xu Z, Li Y, Wang J, Wu B, Li J. Effect of omega-3 polyunsaturated fatty acids to reverse biopsy-proven parenteral nutrition-associated liver disease in adults. Clin Nutr. 2012;31(2):217–23.

    Article  CAS  PubMed  Google Scholar 

  32. Wolfe RR, Allsop JR, Burke JF. Glucose metabolism in man: responses to intravenous glucose infusion. Metabolism. 1979;28(3):210–20.

    Article  CAS  PubMed  Google Scholar 

  33. Nagashimada M, Ota T. Role of vitamin E in nonalcoholic fatty liver disease. IUBMB Life. 2019;71(4):516–22.

    Article  CAS  PubMed  Google Scholar 

  34. Mihatsch WA, Braegger C, Bronsky J, et al. ESPGHAN/ESPEN/ESPR/CSPEN guidelines on pediatric parenteral nutrition. Clin Nutr. 2018;37(6 Pt B):2303–5.

    Article  PubMed  Google Scholar 

  35. Luyckx FH, Desaive C, Thiry A, et al. Liver abnormalities in severely obese subjects: effect of drastic weight loss after gastroplasty. Int J Obes Relat Metab Disord. 1998;22(3):222–6.

    Article  CAS  PubMed  Google Scholar 

  36. Younossi ZM, Koenig AB, Abdelatif D, Fazel Y, Henry L, Wymer M. Global epidemiology of nonalcoholic fatty liver disease-meta-analytic assessment of prevalence, incidence, and outcomes. Hepatology. 2016;64(1):73–84.

    Article  PubMed  Google Scholar 

  37. Mirtallo JM, Dasta JF, Kleinschmidt KC, Varon J. State of the art review: intravenous fat emulsions: current applications, safety profile, and clinical implications. Ann Pharmacother. 2010;44(4):688–700.

    Article  CAS  PubMed  Google Scholar 

  38. Mateu-de Antonio J, Florit-Sureda M. New strategy to reduce hypertriglyceridemia during parenteral nutrition while maintaining energy intake. JPEN J Parenter Enteral Nutr. 2016;40(5):705–12.

    Article  CAS  PubMed  Google Scholar 

  39. Guo YY, Li HX, Zhang Y, He WH. Hypertriglyceridemia-induced acute pancreatitis: progress on disease mechanisms and treatment modalities. Discov Med. 2019;27(147):101–9.

    CAS  PubMed  Google Scholar 

  40. Correani A, Giretti I, Antognoli L, et al. Hypertriglyceridemia and intravenous lipid titration during routine parenteral nutrition in small preterm infants. J Pediatr Gastroenterol Nutr. 2019;69(5):619–25.

    Article  CAS  PubMed  Google Scholar 

  41. Llop JM, Leiva E, Mateu-de Antonio J, et al. Study of hyperglycemia in non critically-ill patients receiving parenteral nutrition: incidence and risk factors. Nutr Hosp. 2012;27(5):1521–6.

    CAS  PubMed  Google Scholar 

  42. Garcia Martinez T, Montanes Pauls B, Vicedo Cabrera AM, Linana Granell C, Ferrando PR. Predictive factors of hyperglycemia in hospitalized adults receiving total parenteral nutrition. Farm Hosp. 2017;41(6):667–73.

    PubMed  Google Scholar 

  43. Pleva M, Mirtallo JM, Steinberg SM. Hyperglycemic events in non-intensive care unit patients receiving parenteral nutrition. Nutr Clin Pract. 2009;24(5):626–34.

    Article  PubMed  Google Scholar 

  44. Drincic AT, Knezevich JT, Akkireddy P. Nutrition and hyperglycemia management in the inpatient setting (meals on demand, parenteral, or enteral nutrition). Curr Diab Rep. 2017;17(8):59.

    Article  PubMed  Google Scholar 

  45. Sangrador Pelluz C, Pardo Pastor J, Navas Moya E, Nicolas Pico J, Quintana S. Predictive factors of hyperglycaemia in patients with parenteral nutrition. Med Clin (Barc). 2020;154(5):157–62.

    Article  CAS  PubMed  Google Scholar 

  46. Sarkisian S, Fenton TR, Shaheen AA, Raman M. Parenteral nutrition-associated hyperglycemia in noncritically ill inpatients is associated with higher mortality. Can J Gastroenterol. 2010;24(7):453–7.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Ma J, Gao M, Pan R, et al. Hyperglycemia is associated with cardiac complications in elderly nondiabetic patients receiving total parenteral nutrition. Medicine (Baltimore). 2018;97(6):e9537.

    Article  CAS  PubMed  Google Scholar 

  48. Olveira G, Tapia MJ, Ocon J, et al. Parenteral nutrition-associated hyperglycemia in non-critically ill inpatients increases the risk of in-hospital mortality (multicenter study). Diabetes Care. 2013;36(5):1061–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  49. Jakoby MG, Nannapaneni N. An insulin protocol for management of hyperglycemia in patients receiving parenteral nutrition is superior to ad hoc management. JPEN J Parenter Enteral Nutr. 2012;36(2):183–8.

    Article  CAS  PubMed  Google Scholar 

  50. Hakeam HA, Mulia HA, Azzam A, Amin T. Glargine insulin use versus continuous regular insulin in diabetic surgical noncritically ill patients receiving parenteral nutrition: randomized controlled study. JPEN J Parenter Enteral Nutr. 2017;41(7):1110–8.

    Article  CAS  PubMed  Google Scholar 

  51. Lee H, Koh SO, Park MS. Higher dextrose delivery via TPN related to the development of hyperglycemia in non-diabetic critically ill patients. Nutr Res Pract. 2011;5(5):450–4.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  52. Leung CF, Lao TT, Chang AM. Effect of folate supplement on pregnant women with beta-thalassaemia minor. Eur J Obstet Gynecol Reprod Biol. 1989;33(3):209–13.

    Article  CAS  PubMed  Google Scholar 

  53. Jeejeebhoy KN, Chu RC, Marliss EB, Greenberg GR, Bruce-Robertson A. Chromium deficiency, glucose intolerance, and neuropathy reversed by chromium supplementation, in a patient receiving long-term total parenteral nutrition. Am J Clin Nutr. 1977;30(4):531–8.

    Article  CAS  PubMed  Google Scholar 

  54. Via MA, Scurlock C, Adams DH, Weiss AJ, Mechanick JI. Impaired postoperative hyperglycemic stress response associated with increased mortality in patients in the cardiothoracic surgery intensive care unit. Endocr Pract. 2010;16(5):798–804.

    Article  PubMed  Google Scholar 

  55. Hernandez-Vazquez AJ, Garcia-Sanchez JA, Moreno-Arriola E, Salvador-Adriano A, Ortega-Cuellar D, Velazquez-Arellano A. Thiamine deprivation produces a liver ATP deficit and metabolic and genomic effects in mice: findings are parallel to those of biotin deficiency and have implications for energy disorders. J Nutrigenet Nutrigenomics. 2016;9(5–6):287–99.

    CAS  PubMed  Google Scholar 

  56. Alaei Shahmiri F, Soares MJ, Zhao Y, Sherriff J. High-dose thiamine supplementation improves glucose tolerance in hyperglycemic individuals: a randomized, double-blind cross-over trial. Eur J Nutr. 2013;52(7):1821–4.

    Article  CAS  PubMed  Google Scholar 

  57. Larrieta E, Vega-Monroy ML, Vital P, et al. Effects of biotin deficiency on pancreatic islet morphology, insulin sensitivity and glucose homeostasis. J Nutr Biochem. 2012;23(4):392–9.

    Article  CAS  PubMed  Google Scholar 

  58. Petrov MS, Basina M. DIAGNOSIS OF ENDOCRINE DISEASE: diagnosing and classifying diabetes in diseases of the exocrine pancreas. Eur J Endocrinol. 2021;184(4):R151–R63.

    Article  CAS  PubMed  Google Scholar 

  59. Overett TK, Bistrian BR, Lowry SF, Hopkins BS, Miller D, Blackburn GL. Total parenteral nutrition in patients with insulin-requiring diabetes mellitus. J Am Coll Nutr. 1986;5(1):79–89.

    Article  CAS  PubMed  Google Scholar 

  60. Ahmed S, Styers JP. Inpatient Diabetes Management. Prim Care. 2022;49(2):339–49.

    Article  PubMed  Google Scholar 

  61. Ramotowska A, Groele L, Mytyk A, Banaszkiewicz A, Szypowska A. Continuous subcutaneous insulin infusion during total parenteral nutrition after gastroscopy complicated by duodenal intramural haematoma in a patient with type 1 diabetes—case report. Pediatr Endocrinol Diabetes Metab. 2016;22(4):170–4.

    Article  PubMed  Google Scholar 

  62. Shimizu H, Shimomura Y, Takahashi M, Kobayashi I, Tomizawa T, Kobayashi S. Enteral hyperalimentation with continuous subcutaneous insulin infusion improved severe diarrhea in poorly controlled diabetic patient. JPEN J Parenter Enteral Nutr. 1991;15(2):181–3.

    Article  CAS  PubMed  Google Scholar 

  63. Bergman M, Ravikumar S, Auerhahn C, et al. Continuous subcutaneous insulin infusion (CSII) reduces counter-regulatory hormone concentrations in a patient receiving enteral hyperalimentation. Diabetes Res. 1986;3(9):487–8.

    CAS  PubMed  Google Scholar 

  64. Bergman M, RaviKumar S, Auerhahn C, DelSavio N, Savino J, Felig P. Insulin pump therapy improves blood glucose control during hyperalimentation. Arch Intern Med. 1984;144(10):2013–5.

    Article  CAS  PubMed  Google Scholar 

  65. Boughton CK, Bally L, Martignoni F, et al. Fully closed-loop insulin delivery in inpatients receiving nutritional support: a two-centre, open-label, randomised controlled trial. Lancet Diabetes Endocrinol. 2019;7(5):368–77.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Endocrinology, Diabetes, and Bone Disease, Mount Sinai Beth Israel Medical Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Michael A. Via

Authors
  1. Michael A. Via
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Michael A. Via .

Editor information

Editors and Affiliations

  1. Division of Endocrinology, Long Island Jewish Medical Center, Northwell Health, New Hyde Park, NY, USA

    Rifka C. Schulman-Rosenbaum

Ethics declarations

 None.

Rights and permissions

Reprints and permissions

Copyright information

© 2023 The Author(s), under exclusive license to Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Via, M.A. (2023). Diabetes and Parenteral Nutrition. In: Schulman-Rosenbaum, R.C. (eds) Diabetes Management in Hospitalized Patients. Contemporary Endocrinology. Springer, Cham. https://doi.org/10.1007/978-3-031-44648-1_28

Download citation

  • DOI: https://doi.org/10.1007/978-3-031-44648-1_28

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-44647-4

  • Online ISBN: 978-3-031-44648-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation