Preventing glycaemic excursions in diabetic patients requiring percutaneous endoscopic gastrostomy (PEG) feeding after a stroke.
OBJECTIVE
Enteral feeding for diabetic patients with a stroke is often associated with hyperglycaemia and/or hypoglycaemia, which can adversely influence neurological recovery. We have developed a structured enteral feeding programme aimed at establishing 'normal' feeding patterns and avoiding marked glycaemic excursions.


RESULTS
Of 332 consecutive patients admitted to an acute stroke unit, 20 of 41 diabetic patients required PEG feeding. Over the initial 24-48 h, patients had 22- h feeds with continuous intravenous infusion of soluble insulin. Thereafter, they were established on three feeds per day. Soluble insulin was given prior to each feed with isophane insulin at 2200 h. Average duration of feed was 13 +/- 8 days with an achieved glucose level of 8.7 +/- 2.5 (mean +/- SD) mmol/l associated with 0.8 episodes of biochemical hypoglycaemia (< 3 mmol/l) each week.


CONCLUSIONS
A structured enteral feeding programme for PEG-fed diabetic patients can improve the quality of care with avoidance of marked glycaemic excursions.
Kerr
D
D
Bournemouth Diabetes and Endocrine Centre, Bournemouth, UK. david.kerr@rbch-tr.swest.nhs.uk
Hamilton
P
P
Cavan
D A
DA
D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose / Q000032:analysis*; D002561:Cerebrovascular Disorders / Q000097:blood / Q000178:diet therapy / Q000534:rehabilitation*; D003680:Deglutition Disorders / Q000534:rehabilitation; D003925:Diabetic Angiopathies / Q000097:blood / Q000178:diet therapy / Q000534:rehabilitation*; D004750:Enteral Nutrition / Q000379:methods; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000517:prevention & control*; D007328:Insulin / Q000008:administration & dosage*; D007441:Intubation, Gastrointestinal / Q000379:methods; D008297:Male; D008875:Middle Aged
D001786:Blood Glucose; D007328:Insulin