title: Use of neutral protamine lispro insulin (NPL) in patients with hyperglycemia receiving parenteral nutrition.
abstract: OBJECTIVE
  Nutritional support with parenteral nutrition (PN), a key component in the care of critically ill patients, usually requires insulin therapy in patients with diabetes or may require insulin treatment in patients not known to be diabetic. We wanted verify whether it is possible to use neutral protamine lispro (NPL) in double administration monotherapy in patients receiving artificial nutrition (AN) and if the same NPL is capable of obtaining and maintaining acceptable glycemic control without inducing hypoglycemia.
  
  
  METHODS
  We studied 18 consecutive patients, who were not taking insulin, they needed to start artificial nutrition, and presenting at least two consecutive blood glucose > 120 mg/dL. Each patient was given at least 1 U of insulin for every 10 grams of glucose infused.
  
  
  RESULTS
  Eighteen consecutive patients, not stratified in any way, were judged eligible in the last 24 months, with a mean age of 71 years (range 54-85 yrs). All patients were evaluated after 2, 3 and 5 days of treatment; only 1 patient has not been evaluated to 5 days. Mean glycemic values on days 2, 3, 5 were in range between 145 and 180 mg/dL. Any adjustments in NPL dose were carried out by the team of nutrition and there was no hypoglycemia that required medical intervention in emergency.
  
  
  CONCLUSIONS
  Our impression is that also lispro protamine insulin (NPL) in double subcutaneous administration may contribute to improving the glycemic values in patients receiving parenteral nutrition with hyperglycemia.
authors.affiliation: Units of Diabetology, Dietology and Clinical Nutrition, "S. Maria" Hospital, Terni, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Fatati
authors.affiliation: Units of Diabetology, Dietology and Clinical Nutrition, "S. Maria" Hospital, Terni, Italy.
authors.forename: I
authors.initials: I
authors.lastname: Grandone
authors.affiliation: Units of Diabetology, Dietology and Clinical Nutrition, "S. Maria" Hospital, Terni, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Palazzi
authors.affiliation: Units of Health Management, "S. Maria" Hospital, Terni, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Weber
authors.affiliation: Units of Diabetology, Dietology and Clinical Nutrition, "S. Maria" Hospital, Terni, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Mirri
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose / Q000187:drug effects; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000188:drug therapy*; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007328:Insulin / Q000031:analogs & derivatives* / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D010288:Parenteral Nutrition; D011479:Protamines / Q000627:therapeutic use*
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin; D011479:Protamines; C110077:neutral protamine lispro insulin