Research Research and Professional Briefs| Volume 113, ISSUE 2, P263-268, February 2013

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Risk Factors for Predicting Hypoglycemia in Patients Receiving Concomitant Parenteral Nutrition and Insulin Therapy

Published:January 23, 2013DOI:


      The occurrence of hypoglycemia in patients receiving parenteral nutrition (PN) is low, yet its consequences can be detrimental. Treatment of hyperglycemia with insulin to achieve optimal blood glucose control is challenging and potentially associated with increased risk of the development of hypoglycemia. The objective of this study was to determine the association of patient characteristics on the risk of hypoglycemia among patients receiving concomitant PN and insulin therapy. This retrospective cohort study was conducted from January 1, 2008, to December 31, 2011, and included 1,657 patients who received PN. There was a significant decrease in the occurrence of hypoglycemia observed over time: 9.1% (43 of 475) in 2008, 6.4% (30 of 468) in 2009, 5.8% (20 of 347) in 2010, and 3.5% (13 of 367) in 2011 (P=0.013). Patients in whom hypoglycemia developed had a significantly longer duration on PN (18.0 vs 8.1 days, P<0.0001) as well as more days requiring insulin in the PN (16.1 vs 2.7 days, P<0.0001). The strongest predictors of hypoglycemia were: receiving PN in the ICU (OR 1.86, 95% CI 1.16 to 3.01), history of diabetes (OR 2.10, 95% CI 1.26 to 3.51), days on PN (OR 0.93, 95% CI 0.91 to 0.95), and an insulin drip (OR 3.14, 95% CI 1.81 to 5.42). With the identification of patient factors that contribute to an increase in hypoglycemia, existing protocols can be modified to treat hyperglycemia and prevent hypoglycemia.


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      K. F. Kinnare is a nutrition support dietitian, Walgreens Infusion Services, Wood Dale, IL; at the time of the study, she was a clinical dietitian at Rush University Medical Center, Chicago, IL.


      C. A. Bacon is a clinical dietitian, Rush University Medical Center, Chicago, IL.


      Y. Chen is a clinical dietitian, Rush University Medical Center, Chicago, IL.


      S. J. Peterson is a clinical dietitian, Rush University Medical Center, Chicago, IL.


      D. C. Sowa is clinical nutrition manager/internship director, Rush University Medical Center, Chicago, IL.