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Intensive Care Medicine
Published in: Intensive Care Medicine 12/2007

01-12-2007 | Original

The relationship between blood glucose control and intolerance to enteral feeding during critical illness

Authors: Nam Nguyen, Katrina Ching, Robert Fraser, Marianne Chapman, Richard Holloway

Published in: Intensive Care Medicine | Issue 12/2007

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Abstract

Objective

To assess the relationship between blood glucose concentrations (BSL) and intolerance to gastric feeding in critically ill patients.

Design

Prospective, case-controlled study.

Patients and participants

Two-hourly BSL and insulin requirements over the first 10 days after admission were assessed in 95 consecutive feed-intolerant (NG aspirate > 250 ml during feed) critically ill patients and 50 age-matched, feed-tolerant patients who received feeds for at least 3 days. Patients with diabetes mellitus were excluded. A standard insulin protocol was used to maintain BSL at 5.0–7.9 mmol.

Measurements and results

The peak BSLs were significantly higher before and during enteral feeding in feed-intolerant patients. The mean and trough BSLs were, however, similar between the two groups on admission, 24 h prior to feeding and for the first 4 days of feeding. The variations in BSLs over 24 h before and during enteral feeding were significantly greater in feed-intolerant patients. A BSL greater than 10 mmol/l was more prevalent in patients with feed intolerance during enteral feeding. The time taken to develop feed intolerance was inversely related to the admission BSL (r = –0.40). The amount of insulin administered before and during enteral feeding was similar between the two groups.

Conclusions

Feed intolerance in critically ill patients is associated with a greater degree of glycaemic variation, with a greater number of patients with transient hyperglycaemia. These data suggest more intensive insulin therapy may be required to minimize feed intolerance, an issue that warrants further study.
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Metadata
Title
The relationship between blood glucose control and intolerance to enteral feeding during critical illness
Authors
Nam Nguyen
Katrina Ching
Robert Fraser
Marianne Chapman
Richard Holloway
Publication date
01-12-2007
Publisher
Springer-Verlag
Published in
Intensive Care Medicine / Issue 12/2007
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-007-0869-7

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