Nutrition in Clinical Practice

 

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Nutrition in Clinical Practice, Vol. 22, No. 5, 545-552 (2007)
DOI: 10.1177/0115426507022005545
© 2007 The American Society for Parenteral and Enteral Nutrition

Clinical Research

A Pilot Study to Evaluate the Effectiveness of Glargine and Multiple Injections of Lispro in Patients With Type 2 Diabetes Receiving Tube Feedings in a Cardiovascular Intensive Care Unit

Angela Grainger, MS, RD*, Kelly Eiden, MS, RD*, Judy Kemper, PhD, RN* and Dominic Reeds, MD{dagger}

* Barnes Jewish College of Nursing and Allied Health, St. Louis, Missouri; and {dagger} Washington University, St. Louis, Missouri

Correspondence: Angela Grainger, Barnes Jewish College of Nursing and Allied Health, 306 S. Kingshighway Blvd., St. Louis, MO 63110. Electronic mail may be sent to angie.g25{at}gmail.com.

Background: The purpose of this study was to evaluate the effectiveness of insulin lispro and insulin glargine at controlling blood glucose in patients with type 2 diabetes mellitus in a cardiovascular intensive care unit (CICU) and receiving enteral tube feedings. Methods: This was a pilot study with a retrospective control designed to evaluate an insulin protocol in patients admitted to the CICU in a level 3 teaching institution. Patients were 18–99 years of age with type 2 diabetes mellitus, receiving bolus tube feeding. The control group included 24 patients who were retrospectively studied to determine mean blood glucose level. A glycemic management protocol was developed that included glargine and lispro insulins to maintain blood glucose levels between 80 and 140 mg/dL. The study group consisted of 28 patients who were treated according to the glycemic management protocol. Results: The mean blood glucose level of the retrospective control group was 225 mg/dL. The mean blood glucose level of the intervention group was 148 mg/dL. After protocol institution, 48.6% of blood glucose levels were within the goal blood glucose range of 80–140 mg/dL vs 8.26% (p = .01) before protocol institution. Hyperglycemia decreased from 90.0% to 47.2% (p < .0001) with institution of the protocol. Conclusions: The average blood glucose of the intervention group was slightly above the goal blood glucose range of 80–140 mg/dL; however, the study protocol was superior to the previous CICU blood glucose management protocol.


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