Glycaemic control in insulin requiring diabetes patients receiving exclusive enteral tube feeding in an acute hospital setting.
OBJECTIVE
Optimising glycaemic control for insulin requiring individuals during enteral feeding is important but difficult. We compare 3 insulin regimens with the aim of improving glucose control and reducing hypoglycaemia.


METHODS
Comparison of 3 insulin/feed regimens: (1) A 20 h feed using a 30:70 premixed insulin (2) Three bolus (4 h) feeds combined with short acting analogue insulin and a basal long acting insulin. (3) A 24 h feed combined with a long acting analogue insulin. The study combined a retrospective analysis of regimen (1) with consecutive prospective analyses of (2) and (3).


RESULTS
Glucose concentrations were suboptimal with higher values during the feeds (12.6 mmol/L ± 4.4 vs 10.3 ± 4.1 p<0.001). Although there was no overall difference in glucose control between groups there was a reduction in hypoglycaemia during the feed in the bolus group (no hypoglycaemia during intermittent feeds p<0.001).


CONCLUSIONS
Glucose concentrations were relatively high overall. Short bolus feeding appears to reduce the frequency of hypoglycaemia. This is of clinical significance for this patient group.
Nutrition and Dietetic Department, Derriford Hospital, Plymouth, United Kingdom.
P M
PM
Murphy
Diabetes and Endocrinology Department, Derriford Hospital, Plymouth, United Kingdom.
E
E
Moore
Diabetes and Endocrinology Department, Derriford Hospital, Plymouth, United Kingdom. Electronic address: danielflanagan@nhs.net.
D E
DE
Flanagan
D000368:Aged; D001786:Blood Glucose / Q000032:analysis; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy*; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D004334:Drug Administration Schedule; D004750:Enteral Nutrition; D005260:Female; D038321:Glycemic Index; D006801:Humans; D007003:Hypoglycemia / Q000517:prevention & control*; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D049528:Insulin, Long-Acting / Q000627:therapeutic use*; D008297:Male; D011446:Prospective Studies; D012189:Retrospective Studies
D001786:Blood Glucose; D007004:Hypoglycemic Agents; D049528:Insulin, Long-Acting
Enteral feeding; Glucose variability; Glycaemic control; Hospital care; Hypoglycaemia; Insulin