Background Total parenteral nutrition (TPN) support requires a multidisciplinary approach from experienced healthcare professionals such as pharmacists, to minimise potential complications. However, on a daily basis clinical practice is common come across with altered blood-glucose concentration in patients on TPN feeding who require closer monitoring with complex and dynamic treatment such as insulin. Despite such potential benefits, insulin added to TPN is still controversial due mainly to the potential risk of hypoglycaemia related to its biodisponibility.
Purpose Analyse and evaluate the efficacy and safety of fast-acting insulin added to TPN admixtures, in patients with altered glycaemia, followed up by nutrition support pharmacists (NSP).
Material and methods Observational and retrospective study carried out in a General Hospital for 19 months (January 2017 to July 2018). Data was collected from electronic clinical records and the electronic prescribing system. Data collected: total patients on TPN with altered blood-sugar levels followed up by the pharmacy team, patients treated with fast-acting insulin (TPN bag additive), daily (three times) blood-sugar levels (BMs), patient’s demographics, hypoglycaemias (blood-sugar levels less than 70 mg/dL) and hyperglycaemias (BMs>180 mg/dL). Patients admitted to the critical care unit (CCU) or not followed up by the pharmacy team were excluded. We considered target BMs between 140–180 mg/dL. All insulin adjustments were done by NSP.
Results The total number of patients on NPT with altered BMs was 148, and 36 (24.3%) patients required fast-acting insulin therapy. Thirty patients were included in this study due to six being admitted to the CCU. Patients included: 20 were males (66.6%), average age 67 years (range 45–91). Twenty-five (83.3%) patients had hyperglycaemia (≥1BMs>180 mg/dL) of whom 17 (56.6%) required fast-acting insulin therapy on the TPN bag. Average NPT duration on fast-acting insulin-treated patients was 10 days (range 3–36). Average days BMs>180 mg/dL:4.5 (range 1–11). Average BMs>180 mg/dL: 242 mg/dL (range 181–427 mg/dL; mode: 220 mg/dL). One patient had hypoglycaemia non-insulin-related. None treated with fast-acting insulin had hypoglycaemia.
Conclusion Despite more than half of the patients treated with fast-acting insulin therapy having hyperglycaemia, none of them had hypoglycaemia. On the other hand, a cautious use of the fast-acting insulin TPN bag added could boost hyperglycaemias in our patients. Administering insulin along with TPN continuously appeared to be a safe method, providing a smoother glycaemic profile.
References and/or acknowledgements https://doi.org/10.1177/0148607117722750
No conflict of interest.