Commonly Asked Questions

  • Sanjeev Kelkar
  • Shubhangi Muley
  • Prakash Ambardekar


Q1: What are the abnormalities/mechanisms which result in type 2 diabetes?


References on Q4: You have mentioned the Leuven studies. Their results are not confirming but often contradictory. How do you explain that?

  1. 1.
    Berghe G, Dodek P. Intravenous insulin nomogram improves blood glucose control in the critically ill. Crit Care Med. 2001;29:1714–9.CrossRefGoogle Scholar
  2. 2.
    Van den Berghe G, et al. Intensive insulin therapy in the medical ICU. N Engl J Med. 2006;354:449–61.CrossRefGoogle Scholar
  3. 3.
    The ACCORD Study Group. Effects of intensive blood-pressure control in type 2 diabetes mellitus. N Engl J Med. 2010;362(17):1575–85, 29 Apr 2010.CrossRefGoogle Scholar
  4. 4.
    Van den Berghe, et al. Intensive insulin therapy in mixed medical/surgical intensive care units: benefit versus harm. Diabetes. 2006;55:3151–9.CrossRefGoogle Scholar

References on Q8: Type 2 diabetes needs many drugs for normoglycemia and many more to control other complications. Are there any significant drug interactions?

  1. 5.
    Scheen Andre J. Drug interactions of clinical importance with antihyperglycemic agents an update. Drug Saf. 2005;28(7):601–31.CrossRefGoogle Scholar
  2. 6.
    UK Prospective Diabetes Study (UKPDS) Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet. 1998;352:837–53.CrossRefGoogle Scholar
  3. 7.
    Surekha V, Peter JV, Jeyaseelan L, et al. Drug interaction: rifampicin and glibenclamide. Natl Med J India. 1997;10:11–2.PubMedGoogle Scholar

References for Q9: What are the indications, contraindications, advantages, disadvantages, and side effects of total parenteral nutrition (TPN)? How is glycemic control affected and how is it managed?

  1. 8.
    Alberti KG, Marshall SM. Diabetes and surgery. In: Alberti KG, Krall LP, editors. Diabetes annual/4. New York: Elsevier; 1988. p. 248–71.Google Scholar
  2. 9.
    Ziegler TR. Parenteral nutrition in the critically ill patient. N Engl J Med. 2009;361:1088–97. [PubMed: 19741230].CrossRefGoogle Scholar
  3. 10.
    McMahon MM, Rizza RA. Nutrition support in the hospitalized patient with diabetes mellitus. Mayo Clinic Proc. 1996;71:587–94.CrossRefGoogle Scholar
  4. 11.
    Bantle JP, Wylie-Rosett J, Albright AL, Apovian CM, Clark NG, Franz MJ, Hoogwerf BJ, Lichtenstein AH, Mayer-Davis E, Mooradian AD, Wheeler ML. Nutrition recommendations and interventions for diabetes: a position statement of the American Diabetes Association. Diabetes Care. 2008;31(Suppl 1):S61–78. Scholar
  5. 12.
    McClave SA, Martindale RG, Vanek VW, 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. 2009;33:277–316.CrossRefGoogle Scholar
  6. 13.
    Mesotten D, Gielen M, Wouters PJ, Desmet L, Vlasselaers D, Vanhorebeek I, Langouche L, Van den Berghe G. Effect of tight glucose control with insulin on the thyroid axis of critically ill children and its relation with outcome. J Clin Endocrinol Metab. 2012;97(10):3569–76. Epub 2012 Aug 7.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 14.
    Van den Berghe G, et al. Intensive insulin therapy in mixed medical/surgical intensive care units: benefit versus harm. Diabetes. 2006;55:3151–9.CrossRefGoogle Scholar
  8. 15.
    van Den Berghe G, et al. Outcome benefit of intensive insulin therapy in the critically ill: Insulin dose versus glycemic control. Crit Care Med. 2003;31(2):359–66.CrossRefGoogle Scholar
  9. 16.
    Moghissi ES, Korytkowski MT, DiNardo M, et al. American Association of Clinical Endocrinologists and American Diabetes Association consensus statement on inpatient glycemic control. Endocr Pract. 2009;15:353–69. [PubMed: 19454396].CrossRefGoogle Scholar
  10. 17.
    Rosmarin DK, Wardlaw GM, Mirtallo J. Hyperglycemia associated with high, continuous infusion rates of total parenteral nutrition dextrose. Nutr Clin Pract. 1996;11:151–6. [PubMed: 9070016].CrossRefGoogle Scholar
  11. 18.
    McCowen KC, Bistrian BR. Hyperglycemia and nutrition support: theory and practice. Nutr Clin Pract. 2004;19:235–44. [PubMed: 16215111].CrossRefGoogle Scholar
  12. 19.
    Ahrens CL, Barletta JF, Kanji S, et al. Effect of low-calorie parenteral nutrition on the incidence and severity of hyperglycemia in surgical patients: a randomized, controlled trial. Crit Care Med. 2005;33:2507–12. [PubMed: 16276174].CrossRefGoogle Scholar
  13. 20.
    Schutz Y, Thiebaud D, Acheson KJ, et al. Thermogenesis induced by five different intravenous glucose/insulin infusions in healthy young men. Clin Nutr. 1983;2:93–6. [PubMed: 16829417].CrossRefGoogle Scholar
  14. 21.
    Askanazi J, Weissman C, Rosenbaum SH, et al. Nutrition and the respiratory system. Crit Care Med. 1982;10:163–72. [PubMed: 6800701].CrossRefGoogle Scholar
  15. 22.
    Casaer MP, Mesotten D, Hermans G, et al. Early vs late parenteral nutrition in critically ill adults. N Engl J Med. 2011;365:506–17. [PubMed: 21714640].CrossRefGoogle Scholar
  16. 23.
    Lidder P, Flanagan D, Fleming S, et al. Combining enteral with parenteral nutrition to improve postoperative glucose control. Br J Nutr. 2010;103:1635–41. [PubMed: 20211036].CrossRefGoogle Scholar
  17. 24.
    Singer P, Berger MM, Van den Berghe G, et al. ESPEN Guidelines on Parenteral Nutrition: intensive care. Clin Nutr. 2009;28:387–400. [PubMed: 19505748].CrossRefGoogle Scholar
  18. 25.
    Via MA, Mechanick JI. Inpatient enteral and parental nutrition for patients with diabetes. Curr Diab Rep. 2011;11:99–105. [PubMed: 21170688].CrossRefGoogle Scholar
  19. 26.
    Gosmanov AR, Umpierrez GE. Medical nutrition therapy in hospitalized patients with diabetes. Curr Diab Rep. 2012;12:93–100. [PubMed: 21997598].CrossRefGoogle Scholar
  20. 27.
    Yaqoob P. Lipids and the immune response. Curr Opin Clin Nutr Metab Care. 1998;1:153–61. [PubMed: 10565342].CrossRefGoogle Scholar
  21. 28.
    Yaqoob P. Monounsaturated fatty acids in parenteral nutrition; evaluation of risks and benefits. Br J Nutr. 2005;94:867–8. [PubMed: 16351759].CrossRefGoogle Scholar
  22. 29.
    Buenestado A, Cortijo J, Sanz MJ, et al. Olive oil-based lipid emulsion’s neutral effects on neutrophil functions and leukocyte-endothelial cell interactions. JPEN J Parenter Enteral Nutr. 2006;30:286–96.CrossRefGoogle Scholar
  23. 30.
    Garcia-de-Lorenzo A, Denia R, Atlan P, et al. Parenteral nutrition providing a restricted amount of linoleic acid in severely burned patients: a randomized double-blind study of an olive oil-based lipid emulsion vs medium/long-chain triacylglycerols. Br J Nutr. 2005;94:221–30. [PubMed: 16115356].CrossRefGoogle Scholar
  24. 31.
    Siqueira J, Smiley D, Newton C, et al. Substitution of standard soybean oil with olive oil-based lipid emulsion in parenteral nutrition: comparison of vascular, metabolic, and inflammatory effects. J Clin Endocrinol Metab. 2011;96:3207–16. [PubMed: 21832112].CrossRefGoogle Scholar
  25. 32.
    Umpierrez GE, Spiegelman R, Zhao V, et al. A double-blind, randomized clinical trial comparing soybean oil-based vs olive oil-based lipid emulsions in adult medical-surgical intensive care unit patients requiring parenteral nutrition. Crit Care Med. 2012;40:1792–8. [PubMed: 22488002].CrossRefGoogle Scholar
  26. 33.
    Cheung NW, Napier B, Zaccaria C, Fletcher JP. Hyperglycemia is associated with adverse outcomes in patients receiving total parenteral nutrition. Diabetes Care. 2005;28:2367–71. [PubMed: 16186264].CrossRefGoogle Scholar
  27. 34.
    Pasquel FJ, Spiegelman R, McCauley M, et al. Hyperglycemia during total parenteral nutrition: an important marker of poor outcome and mortality in hospitalized patients. Diabetes Care. 2010;33:739–41. [PubMed: 20040658].CrossRefGoogle Scholar
  28. 35.
    Quigley EM, Marsh MN, Shaffer JL, Markin RS. Hepatobiliary complications of total parenteral nutrition. Gastroenterology. 1993;104:286–301. [PubMed: 8419252].CrossRefGoogle Scholar
  29. 36.
    Sajbel TA, Dutro MP, Radway PR. Use of separate insulin infusions with total parenteral nutrition. JPEN J Parenter Enteral Nutr. 1987;11:97–9.CrossRefGoogle Scholar
  30. 37.
    Hongsermeier T, Bistrian BR. Evaluation of a practical technique for determining insulin requirements in diabetic patients receiving total parenteral nutrition. JPEN J Parenter Enteral Nutr. 1993;17:16–9.CrossRefGoogle Scholar
  31. 38.
    Valero MA, Leon-Sanz M, Escobar I, et al. Evaluation of non-glucose carbohydrates in parenteral nutrition for diabetic patients. Eur J Clin Nutr. 2001;55:1111–6. [PubMed: 11781679].CrossRefGoogle Scholar
  32. 39.
    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;36:183–8.CrossRefGoogle Scholar
  33. 40.
    Sarkisian S, Fenton TR, Shaheen AARaman M, Raman M. Parenteral nutrition-associated hyperglycemia in noncritically ill inpatients is associated with higher mortality. Canadian journal of gastroenterology. J Can Gastroenterol. 2010;24:453–7. [PubMed: 20652162].CrossRefGoogle Scholar

References for Q10: How has the Alberti regime evolved over years? Its transition to the insulin infusion through to the Syringe pump needs more clarification

  1. 41.
    Milaskiewicz RM, Hall GM. Diabetes and anaesthesia: the past decade. Br J Anaesth. 1992;68(2):198–206.CrossRefGoogle Scholar
  2. 42.
    Eldridge AJ, Sear JW. Peri-operative management of diabetic patients. Any changes for the better since 1985? Anaesthesia. 1996;51:45–51.CrossRefGoogle Scholar
  3. 43.
    Achinger SG, Ayus JC, Moritz ML. Dysnatremias: why are patients still dying? South Med J. 2006;4:353–62.CrossRefGoogle Scholar
  4. 44.
    Grant IS, Nimmo GR, Nimmo S. Intercurrent disease and anaesthesia. In: Aitkenhead AR, Smith G, Rowbotham DJ, editors. Textbook of anaesthesia. Oxford: Churchill Livingstone Elsevier; 2007. p. 466–8.Google Scholar

References for Q17: Are there formulae to calculate insulin doses while converting a patient on IV insulin to subcutaneous insulin?

  1. 45.
    Donaldson S, Villanuueva G, Rondinelli L, Baldwin D. Rush University guidelines and protocols for the management of hyperglycemia in hospitalized patients: elimination of the sliding scale and improvement of glycemic control throughout the hospital. Diabetes Educ. 2006;32:954–62.CrossRefGoogle Scholar
  2. 46.
    Furnary AP, Braithwaite SS. Effects of outcome on in-hospital transition from intravenous insulin infusion to subcutaneous therapy. Am J Cardiol. 2006;98:557–64.CrossRefGoogle Scholar
  3. 47.
    O’Malley CW, Emanuele M, Halasyamani L, Amin AN. Bridge over troubled waters: safe and effective transitions of the inpatient with hyperglycemia. J Hosp Med. 2008;3:55–65.CrossRefGoogle Scholar
  4. 48.
    Ramos P, Childers D, Maynard G, et al. Maintaining glycemic control when transitioning from infusion insulin: a protocol driven, multidisciplinary approach. J Hosp Med. 2010;5:446–51.CrossRefGoogle Scholar
  5. 49.
    Avanzini F, Marelli G, Donzelli W, et al. Transition from intravenous to subcutaneous insulin: effectiveness and safety of a standardized protocol and predictors of outcome in patients with acute coronary syndrome. Diabetes Care. 2011;34:1445–50.CrossRefGoogle Scholar
  6. 50.
    Magaji V, Johnston J. Inpatient management of hyperglycemia and diabetes. Clin Diab. 2011;29:3–9.CrossRefGoogle Scholar

Additional Reading

  1. Australian Diabetes Educators Association. Sick day management of adults with type 2 diabetes. Canberra: ADEA; 2014.Google Scholar
  2. Robins M, Coles M, Smith D, Armstrong M, Bryant W, Homeming L, on behalf of the Australian Diabetes Educators Association. Clinical guiding principles for sick day management of adults with type 1 and type 2 diabetes. Technical document. Canberra: ADEA; 2014.Google Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  • Sanjeev Kelkar
    • 1
  • Shubhangi Muley
    • 2
  • Prakash Ambardekar
    • 3
  1. 1.Private PracticePuneIndia
  2. 2.Senior Consultant AnesthesiologistCentral India Institute of Medical ScienceNagpurIndia
  3. 3.Consultant, AnesthesioligistFortis S L Raheja HospitalMumbaiIndia

Personalised recommendations