The relationship between blood glucose control and intolerance to enteral feeding during critical illness.
OBJECTIVE
To assess the relationship between blood glucose concentrations (BSL) and intolerance to gastric feeding in critically ill patients.


METHODS
Prospective, case-controlled study.


METHODS
Two-hourly BSL and insulin requirements over the first 10 days after admission were assessed in 95 consecutive feed-intolerant (NG aspirate > 250 ml during feed) critically ill patients and 50 age-matched, feed-tolerant patients who received feeds for at least 3 days. Patients with diabetes mellitus were excluded. A standard insulin protocol was used to maintain BSL at 5.0-7.9 mmol.


RESULTS
The peak BSLs were significantly higher before and during enteral feeding in feed-intolerant patients. The mean and trough BSLs were, however, similar between the two groups on admission, 24 h prior to feeding and for the first 4 days of feeding. The variations in BSLs over 24 h before and during enteral feeding were significantly greater in feed-intolerant patients. A BSL greater than 10 mmol/l was more prevalent in patients with feed intolerance during enteral feeding. The time taken to develop feed intolerance was inversely related to the admission BSL (r= -0.40). The amount of insulin administered before and during enteral feeding was similar between the two groups.


CONCLUSIONS
Feed intolerance in critically ill patients is associated with a greater degree of glycaemic variation, with a greater number of patients with transient hyperglycaemia. These data suggest more intensive insulin therapy may be required to minimize feed intolerance, an issue that warrants further study.
Nguyen
Nam
N
Department of Gastroenterology, Hepatology and General Medicine, Royal Adelaide Hospital, North Terrace, Adelaide, 5000, Australia. quoc.nguyen@health.sa.gov.au
Ching
Katrina
K
Fraser
Robert
R
Chapman
Marianne
M
Holloway
Richard
R
D001315:Australia; D001786:Blood Glucose / Q000032:analysis*; D016022:Case-Control Studies; D016638:Critical Illness; D004750:Enteral Nutrition / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies
D001786:Blood Glucose