Nutrison Diason Energy HP

Inpatients are at risk of poor glycaemic control^1,2. 

Nutritional support strategies for patients with hyperglycaemia

Enteral tube feeds have been found to produce a more rapid rise in blood glucose levels than a nutritionally equivalent solid meal.

Controlling blood glucose levels may improve patient outcomes - patient safety and cost^4,5

Causes of hyperglycaemia

The underlying cause of hyperglycaemia is usually loss of insulin producing cells in the pancreas or development of resistance to insulin

Contributing factors of hyperglycaemia

1. Missing a dose of diabetic medication, tablets or insulin⁵
2. New medication or change in medication, e.g. steroids⁵
3. Overfeeding⁶
4. Stress - physical (e.g. an injury or surgery), mental or emotional
5. Infection of illness⁷

Symptoms of hyperglycaemia

Patient types at risk of hyperglycaemia

The impact of hyperglycaemia^16-18

Managing tube fed patients with hyperglycaemia

Multidisciplinary team approach

Goals of dietetic intervention:

• Prioritise meeting the patient's nutritional requirements
• Monitor carbohydrate intake
• Communicate with the multidisciplary team
• Switch feeding method - bolus vs continuous
• Trying a slower feeding rate
• Try a high protein or high fibre tube feed

What are diabetes specific formulas?^16-18

Clinical benefits of diabetes specific formulas

Cost saving benefits of diabetes specific formulas

A UNIQUE tube feed designed for patients with hyperglycaemia

*Isomaltulose has a slow hydrolysis rate resulting in a reduced glucose and insulin response²⁴

**A mixture of soluble and insoluble fibres to help maintain gut health including gut integrity and bowel function²⁵

Nutrison Diason Energy HP has been proven to improve glucose levels²³

1. World Health Organization, 2006. Definition and diagnosis of diabetes mellitus and intermediate hyperglycaemia.
2. Gandy J. 2015. Manual of Dietetic Practice.
3. Pancorbo-Hidalgo PL, et al. Complications associated with enteral nutrition by nasogastric tube in an internal medicine unit. J Clin Nurs. 2001; 10(4):482-90.
4. McMahon MM, et al. A.S.P.E.N. clinical guidelines: nutrition support of adult patients with hyperglycemia. JPEN J Parenter Enteral Nutr. 2013; 37(1):23-36. https://aspenjournals.onlinelibrary.wiley.com/doi epdf/10.1177/0148607112452001
5. Davidson P, et al. Management of Hyperglycemia and Enteral Nutrition in the Hospitalized Patient. Nutr Clin Pract. 2015; 30(5):652-9.
6. González Infantino CA, et al. Hyperglycemia and hypoalbuminemia as prognostic mortality factors in patients with enteral feeding. Nutrition. 2013; 29(3):497-501.
7. Meizoso JP, et al. Admission hyperglycemia is associated with different outcomes after blunt versus penetrating trauma. J Surg Res. 2016; 206(1):83-9.
8. Honiden S, et al. Metabolic Management during Critical Illness: Glycemic Control in the ICU. Semin Respir Crit Care Med. 2015; 36(6):859-69. https://www.thieme-connect.com/products/ejournals/pdf/10.1055/s-0035-1565253.pdf
9. Plummer MP, et al. Dysglycaemia in the critically ill and the interaction of chronic and acute glycaemia with mortality. Intensive Care Med. 2014; 40(7):973-80.
10. Umpierrez GE, et al. Hyperglycemia: an independent marker of in-hospital mortality in patients with undiagnosed diabetes. J Clin Endocrinol Metab. 2002; 87(3):978-82. https://academic.oup.com/jcem/article/87/3/978/2846522
11. Hwangbo Y, et al. Acute Hyperglycemia Associated with Anti-Cancer Medication. Endocrinol Metab (Seoul). 2017; 32(1):23-9. https://www.e-enm.org/upload/pdf/enm-32-23.pdf
12. Habib SL, et al. Diabetes and risk of cancer. ISRN Oncology. 2013; 2013:583786.
13. National Diabetes Audit, 2017.
14. Lau LH, et al. Prevalence of diabetes and its effects on stroke outcomes: A meta-analysis and literature review. J Diabetes Investig. 2019; 10(3):780-92. https://onlinelibrary.wiley.com/doi/epdf/10.1111/jdi.12932
15. Mi D, et al. Correlation of hyperglycemia with mortality after acute ischemic stroke. Ther Adv Neurol Disord. 2017; 11:1756285617731686. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5784549/
16. Elia M, et al. Enteral nutritional support and use of diabetes-specific formulas for patients with diabetes: a systematic review and meta-analysis. Diabetes Care. 2005; 28(9):2267-79. https://care.diabetesjournals.org/content/28/9/2267.long
17. Ojo O, et al. Evaluation of the role of enteral nutrition in managing patients with diabetes: a systematic review. Nutrients. 2014; 6(11):5142-52. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4245584/
18. American Diabetes Association. Diabetes Care in the Hospital. Diabetes Care. 2017; 40(Suppl 1).
19. Sanz-París A, et al. Diabetes-specific formulas high in monounsaturated fatty acids and metabolic outcomes in patients with diabetes or hyperglycaemia. A systematic review and meta-analysis. Clin Nutr. 2020; 39(11):3273-82.
20. Hamdy O, et al. Differences in resource utilization between patients with diabetes receiving glycemia-targeted specialized nutrition vs standard nutrition formulas in U.S. hospitals. JPEN J Parenter Enteral Nutr. 2014; 38(2 Suppl):86s-91s.
21. Han YY, et al. The clinical and economic impact of the use of diabetes-specific enteral formula on ICU patients with type 2 diabetes. Clin Nutr. 2017; 36(6):1567-72.
22. Barazzoni R, et al. Carbohydrates and insulin resistance in clinical nutrition: Recommendations from the ESPEN expert group. Clin Nutr. 2017; 36(2):355-63.
23. Lansink M, et al. Improved Glucose Profile in Patients With Type 2 Diabetes With a New, High-Protein, Diabetes-Specific Tube Feed During 4 Hours of Continuous Feeding. JPEN J Parenter Enteral Nutr. 2017; 41(6):968-75.
24. Lina BAR, et al. Isomaltulose (Palatinose®): a review of biological and toxicological studies. Food and Chemical Toxicology. 2002; 40(10):1375-81.
25. Green CJ. Fibre in enteral nutrition. Clinical Nutrition. 2001; 20(1):23-39.