Recomendaciones para el soporte nutricional y metabólico especializado del paciente crítico. Actualización. Consenso SEMICYUC-SENPE: Hiperglucemia y diabetes mellitus

Feb 8, 2012Medicina intensiva

Updated Guidelines for Nutritional and Metabolic Support in Critically Ill Patients with High Blood Sugar and Diabetes

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Abstract

Hyperglycemia is a major metabolic disturbance in critically-ill patients, linked to increased morbidity and mortality.

Blood glucose levels should be controlled to avoid both hypoglycemia and elevated concentrations.
Insulin is often necessary to maintain glucose levels within a normal range, particularly in avoiding tight glycemic control protocols.
Adjusting energy intake to meet patients' requirements can prevent hyperglycemia and its complications.
Protein intake should correspond to the level of metabolic stress experienced by the patient.
Enteral nutrition is preferred over parenteral nutrition to reduce the risk of hyperglycemia and decrease insulin needs.
Specific diets featuring low glycemic index carbohydrates, fiber, and monounsaturated fatty acids may enhance glycemic control with reduced insulin requirements.

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Hyperglycemia is one of the main metabolic disturbances in critically-ill patients and is associated with increased morbidity and mortality. Consequently, blood glucose levels must be safely and effectively controlled, that is, maintained within a normal range, avoiding hypoglycemia on the one hand and elevated glucose concentrations on the other. To accomplish this aim, insulin is often required, avoiding protocols designed to achieve tight glycemic control. To prevent hyperglycemia and its associated complications, energy intake should be adjusted to patients' requirements, avoiding overnutrition and excessive glucose intake. Protein intake should be adjusted to the degree of metabolic stress. Whenever patients require artificial feeding, the enteral route, if not contraindicated, should be used since parenteral nutrition is associated with a higher frequency of hyperglycemia and greater insulin requirements. Enteral nutrition should be administered early, preferably within the first 24 hours of admission to the intensive care unit, after hemodynamic stabilization. Specific diets for hyperglycemia, containing low glycemic index carbohydrates and fibre and enriched with monounsaturated fatty acids, can achieve good glycemic control with lower insulin requirements.

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