title: Aging exaggerates the blood glucose response to total parenteral nutrition.
abstract: OBJECTIVE
  To determine the effect of age on the blood glucose and insulin responses to a clinical model of glucose loading (i.e., total parenteral nutrition [TPN] with hypertonic glucose), in patients with a variety of conditions.
  
  
  METHODS
  A prospective cohort study.
  
  
  METHODS
  An adult university hospital.
  
  
  METHODS
  Seventy-one consecutive, clinically stable patients receiving central TPN, excluding those with metabolic disease or receiving relevant medications.
  
  
  METHODS
  None.
  
  
  METHODS
  Serum levels of glucose, insulin, C-peptide and cortisol determined in peripheral venous blood obtained immediately before initiating TPN and again 48 to 96 hours later; acute physiology score (APS) and habitual level of physical activity (HAL).
  
  
  RESULTS
  Serum levels of glucose, insulin and C-peptide increased following initiation of TPN (all p < 0.001). The serum glucose level during TPN administration increased as a function of both patient age and severity of illness (APS) (r2 = 0.37, all p < 0.01), whereas the serum insulin level was inversely related to age and increased as a function of serum glucose, glucose rate of infusion and HAL (r2 = 0.57, all p < 0.05). The serum C-peptide: insulin molar ratio did not vary with age.
  
  
  CONCLUSIONS
  Aging and severity of illness interact to exaggerate the increases in blood glucose that accompany TPN with hypertonic glucose. Serum insulin responses to TPN decline with aging, likely reflecting reduced insulin secretion. Diminished insulin responses may contribute to hyperglycemia and represent a diminished anabolic signal in such patients. The acutely ill elderly patient is predisposed to hyperglycemia and should be monitored carefully even when pre-TPN blood glucose values are normal.
authors.affiliation: Department of Surgery, University of Ottawa, Ont.
authors.forename: J M
authors.initials: JM
authors.lastname: Watters
authors.forename: S M
authors.initials: SM
authors.lastname: Kirkpatrick
authors.forename: D
authors.initials: D
authors.lastname: Hopbach
authors.forename: S B
authors.initials: SB
authors.lastname: Norris
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000378:metabolism*; D001786:Blood Glucose / Q000378:metabolism*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007328:Insulin / Q000097:blood; D008297:Male; D008875:Middle Aged; D010289:Parenteral Nutrition, Total; D011446:Prospective Studies; D012720:Severity of Illness Index
chemical_list: D001786:Blood Glucose; D007328:Insulin