CLINICAL MANAGEMENT OF HYPERGLYCEMIC PATIENTS RECEIVING TOTAL PARENTERAL-NUTRITION

We evaluated the course of total parenteral nutrition (TPN) therapy in patients with hyperglycaemia. We studied 1) incidence of hyperglycaem ia, 2) amount of glucose and insulin provided and 3) incidence of meta bolic problems in patients receiving TPN who required insulin to attai n metabolic control, The group included 91 patients, 38 women (64 +/- 15 years) and 53 men (64 +/- 12 years), who developed glycaemia higher than 200 mg/dl. Nine patients had a previous diagnosis of IDDM, 36 NI DDM and 46 secondary hyperglycaemia. Total caloric requirements were i nitially supplied at 132 +/- 20% the basal energy expenditure (Harris- Benedict formula), and 1.4 +/- 0.3 g/kg of amino-acids, Initially, TPN provided 150-200 g/day of glucose (2.1 mg/kg/min). Regular insulin wa s added to the bag. The annual incidence of hyperglycaemia was estimat ed to be 121 per 1000 patients. Mean insulin requirements were 50 U/da y (25 to 150 U/day), 0.7 +/- 0.3 U/kg, Comparing with prehospitalizati on insulin dose, 22% needed similar doses, and 11% lower doses. IDDM p atients needed 1.7 times their pre-admission dose (1-4.5 times). The r atio of insulin:glucose in TPN was 0.3 +/- 0.1 U/g (0.1-1.2 U/g). Pati ents with renal failure had similar insulin requirements (56 +/- 26 U/ day) than patients with normal renal function (49 +/- 19 U/day). None of the patients developed glycemic complications. In conclusion, diabe tic patients receiving TPN have an acceptable metabolic control if ind ividualized prescriptions and supplemental insulin are used.