title: Recommendations of the GARIN group for managing non-critically ill patients with diabetes or stress hyperglycaemia and artificial nutrition.
abstract: OBJECTIVE
  By means of this update, the GARIN working group aims to define its position regarding the treatment of patients with diabetes or stress hyperglycaemia and artificial nutrition. In this area there are many aspects of uncertainty, especially in non-critically ill patients.
  
  
  METHODS
  Bibliographical review, and specific questions in advance were discussed and answered at a meeting in the form of conclusions.
  
  
  RESULTS
  We propose a definition of stress hyperglycaemia. The indications and access routes for artificial nutrition are no different in patients with diabetes/stress hyperglycaemia than in non-diabetics. The objective must be to keep pre-prandial blood glucose levels between 100 and 140 mg/dl and post-prandial levels between 140 and 180 mg/dl. Hyperglycemia can be prevented through systematic monitoring of capillary glycaemias and adequately calculate energy-protein needs. We recommend using enteral formulas designed for patients with diabetes (high monounsaturated fat) to facilitate metabolic control. The best drug treatment for treating hyperglycaemia/diabetes in hospitalised patients is insulin and we make recommendations for adapt the theoretical insulin action to the nutrition infusion regimen. We also addressed recommendations for future investigation.
  
  
  CONCLUSIONS
  This recommendations about artificial nutrition in patients with diabetes or stress hyperglycaemia can add value to clinical work.
authors.affiliation: Servicio de Endrocrinología y Nutrición, Hopital Regional Universitario Carlos Haya, Málaga, España. gabrielm.olveira.sspa@juntadeandalucia.es
authors.forename: G
authors.initials: G
authors.lastname: Olveira
authors.forename: P P
authors.initials: PP
authors.lastname: García-Luna
authors.forename: J L
authors.initials: JL
authors.lastname: Pereira
authors.forename: I
authors.initials: I
authors.lastname: Rebollo
authors.forename: J M
authors.initials: JM
authors.lastname: García-Almeida
authors.forename: P
authors.initials: P
authors.lastname: Serrano
authors.forename: J A
authors.initials: JA
authors.lastname: Irles
authors.forename: A
authors.initials: A
authors.lastname: Muñoz-Aguilar
authors.forename: M J
authors.initials: MJ
authors.lastname: Molina
authors.forename: M J
authors.initials: MJ
authors.lastname: Tapia
mesh_terms: D003920:Diabetes Mellitus / Q000628:therapy*; D004750:Enteral Nutrition; D005526:Food, Formulated; D006801:Humans; D006943:Hyperglycemia / Q000209:etiology / Q000628:therapy*; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007328:Insulin / Q000627:therapeutic use; D009752:Nutritional Status; D018529:Nutritional Support; D013312:Stress, Physiological / Q000502:physiology*
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin