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Transitional NPH insulin therapy for critically ill patients receiving continuous enteral nutrition and intravenous regular human insulin.
JPEN J Parenter Enteral Nutr. 2013 Jul; 37(4):506-16.JJ

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.

Authors+Show Affiliations

Department of Clinical Pharmacy, University of Tennessee Health Science Center, Memphis, Tennessee 38163, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

22914894

Citation

Dickerson, Roland N., et al. "Transitional NPH Insulin Therapy for Critically Ill Patients Receiving Continuous Enteral Nutrition and Intravenous Regular Human Insulin." JPEN. Journal of Parenteral and Enteral Nutrition, vol. 37, no. 4, 2013, pp. 506-16.
Dickerson RN, Wilson VC, Maish GO, et al. Transitional NPH insulin therapy for critically ill patients receiving continuous enteral nutrition and intravenous regular human insulin. JPEN J Parenter Enteral Nutr. 2013;37(4):506-16.
Dickerson, R. N., Wilson, V. C., Maish, G. O., Croce, M. A., Minard, G., & Brown, R. O. (2013). Transitional NPH insulin therapy for critically ill patients receiving continuous enteral nutrition and intravenous regular human insulin. JPEN. Journal of Parenteral and Enteral Nutrition, 37(4), 506-16. https://doi.org/10.1177/0148607112458526
Dickerson RN, et al. Transitional NPH Insulin Therapy for Critically Ill Patients Receiving Continuous Enteral Nutrition and Intravenous Regular Human Insulin. JPEN J Parenter Enteral Nutr. 2013;37(4):506-16. PubMed PMID: 22914894.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Transitional NPH insulin therapy for critically ill patients receiving continuous enteral nutrition and intravenous regular human insulin. AU - Dickerson,Roland N, AU - Wilson,Vera C, AU - Maish,George O,3rd AU - Croce,Martin A, AU - Minard,Gayle, AU - Brown,Rex O, Y1 - 2012/08/22/ PY - 2012/8/24/entrez PY - 2012/8/24/pubmed PY - 2014/1/18/medline KW - diabetes KW - endocrinology KW - enteral nutrition KW - life cycle SP - 506 EP - 16 JF - JPEN. Journal of parenteral and enteral nutrition JO - JPEN J Parenter Enteral Nutr VL - 37 IS - 4 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. SN - 1941-2444 UR - https://www.unboundmedicine.com/medline/citation/22914894/Transitional_NPH_insulin_therapy_for_critically_ill_patients_receiving_continuous_enteral_nutrition_and_intravenous_regular_human_insulin_ L2 - https://doi.org/10.1177/0148607112458526 DB - PRIME DP - Unbound Medicine ER -