title: The relationship between blood glucose control and intolerance to enteral feeding during critical illness.
abstract: 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.
authors.affiliation: Department of Gastroenterology, Hepatology and General Medicine, Royal Adelaide Hospital, North Terrace, Adelaide, 5000, Australia. quoc.nguyen@health.sa.gov.au
authors.forename: Nam
authors.initials: N
authors.lastname: Nguyen
authors.forename: Katrina
authors.initials: K
authors.lastname: Ching
authors.forename: Robert
authors.initials: R
authors.lastname: Fraser
authors.forename: Marianne
authors.initials: M
authors.lastname: Chapman
authors.forename: Richard
authors.initials: R
authors.lastname: Holloway
mesh_terms: 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
chemical_list: D001786:Blood Glucose