CHAPTER 4 BOX 4.2 Insulin Therapy Options During Parenteral Nutrition14,18-21,24


Insulin added to parenteral nutritiona Recommended patient population


Advantages Ease of implementation


Provides “steady” infusion of insulin along with carbohydrate provided by parenteral nutrition (PN)


Disadvantages


If PN is discontinued abruptly, the source of exogenous insulin is also discontinued


Correctional scale (sliding scale)


Recommended patient population


Advantages Disadvantages


Patients who are stable (non-ICU) and selected patients in the ICU


Ease of implementation Less likely to cause hypoglycemia compared to CII


If PN is abruptly discontinued, hypoglycemia may ensue


“Reactive” method of treatment based on blood glucose level


Correctional scale not always optimal and often requires adjustment


Continuous insulin infusion


Recommended patient population


Advantages


Patients who are critically ill Patients with significant hyperglycemia


Achieving a blood glucose goal of 140 to 180 mg/ dL in the ICU is associated with decreased incidence of hypoglycemia compared to tight glycemic control (80–110 mg/ dL)


Disadvantages Risk of hypoglycemia


Impact on nursing time to safely implement, monitor, and treat blood glucose levels


a


Typical initial dose is 0.1 units of insulin per gram of dextrose; add 50% to 60% of the insulin given through the correctional scale from previous 24 hours into the next bag.


Patients who are stable (non-ICU)


Patients in the ICU but not receiving continuous insulin infusion (CII)


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