Transitional NPH insulin therapy for critically Ill patients receiving continuous enteral nutrition and intravenous regular human insulin

Roland Dickerson, Vera C. Wilson, George O. Maish, Martin Croce, Gayle Minard, Rex Brown

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18 Citations (Scopus)

Abstract

Background: The intent of this study was to evaluate the efficacy and safety of transitioning from a continuous intravenous (IV) regular human insulin (RHI) or intermittent IV RHI therapy to subcutaneous neutral protamine Hagedorn (NPH) insulin with intermittent corrective IV RHI for critically ill patients receiving continuous enteral nutrition (EN). Methods: Data were obtained from critically ill trauma patients receiving continuous EN during transitional NPH insulin therapy. Target blood glucose concentration (BG) range was 70-149 mg/dL. BG was determined every 1-4 hours. Results: Thirty-two patients were transitioned from a continuous IV RHI infusion (CIT) to NPH with intermittent corrective IV RHI therapy. Thirty-four patients had NPH added to their preexisting supplemental intermittent IV RHI therapy (SIT). BG concentrations were maintained in the target range for 18 ± 3 and 15 ± 4 h/d for the CIT and SIT groups, respectively (P <.05). Thirty-eight percent of patients experienced a BG <60 mg/dL, and 9% had a BG <40 mg/dL. Hypoglycemia was more prevalent for those who were older (P <.01) or exhibited greater daily BG variability (P <.01) or worse HgbA1C (p < 0.05). Conclusion: Transitional NPH therapy with intermittent corrective IV RHI was effective for achieving BG concentrations within 70-149 mg/dL for the majority of the day. NPH therapy should be implemented with caution for those who are older, have erratic daily BG control, or have poor preadmission glycemic control.

Original languageEnglish (US)
Pages (from-to)506-516
Number of pages11
JournalJournal of Parenteral and Enteral Nutrition
Volume37
Issue number4
DOIs
StatePublished - Jul 1 2013

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Insulin, Regular, Human
Isophane Insulin
Enteral Nutrition
Critical Illness
Blood Glucose
Protamines
Therapeutics
Hypoglycemia
Safety

All Science Journal Classification (ASJC) codes

  • Medicine (miscellaneous)
  • Nutrition and Dietetics

Cite this

Transitional NPH insulin therapy for critically Ill patients receiving continuous enteral nutrition and intravenous regular human insulin. / Dickerson, Roland; Wilson, Vera C.; Maish, George O.; Croce, Martin; Minard, Gayle; Brown, Rex.

In: Journal of Parenteral and Enteral Nutrition, Vol. 37, No. 4, 01.07.2013, p. 506-516.

Research output: Contribution to journalArticle

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AU - Wilson, Vera C.

AU - Maish, George O.

AU - Croce, Martin

AU - Minard, Gayle

AU - Brown, Rex

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N2 - Background: The intent of this study was to evaluate the efficacy and safety of transitioning from a continuous intravenous (IV) regular human insulin (RHI) or intermittent IV RHI therapy to subcutaneous neutral protamine Hagedorn (NPH) insulin with intermittent corrective IV RHI for critically ill patients receiving continuous enteral nutrition (EN). Methods: Data were obtained from critically ill trauma patients receiving continuous EN during transitional NPH insulin therapy. Target blood glucose concentration (BG) range was 70-149 mg/dL. BG was determined every 1-4 hours. Results: Thirty-two patients were transitioned from a continuous IV RHI infusion (CIT) to NPH with intermittent corrective IV RHI therapy. Thirty-four patients had NPH added to their preexisting supplemental intermittent IV RHI therapy (SIT). BG concentrations were maintained in the target range for 18 ± 3 and 15 ± 4 h/d for the CIT and SIT groups, respectively (P <.05). Thirty-eight percent of patients experienced a BG <60 mg/dL, and 9% had a BG <40 mg/dL. Hypoglycemia was more prevalent for those who were older (P <.01) or exhibited greater daily BG variability (P <.01) or worse HgbA1C (p < 0.05). Conclusion: Transitional NPH therapy with intermittent corrective IV RHI was effective for achieving BG concentrations within 70-149 mg/dL for the majority of the day. NPH therapy should be implemented with caution for those who are older, have erratic daily BG control, or have poor preadmission glycemic control.

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