The Challenge of Blood Glucose Management in Diabetic Patients Receiving Enteral or Parenteral Nutrition

When patients with diabetes require the use of par-enteral or enteral nutrition, blood glucose management can be difficult, and if not done correctly can lead to the development of hyperosmolar nonketotic syndrome. ’ In this issue, Drs Hongsermeier and Bistrian describe their clinical experience using a protocol for the determination of insulin doses and the amount of dextrose infused in patients with insulin-requiring diabetes receiving central parenteral nutrition (CPN). ’ Managing such patients is often difficult, and the authors are to be commended for attempting to define and evaluate a rational approach to this problem. However, the study is primarily a descrip-tive one-the protocols used were not strictly applied in a prospective manner; rather they were used by a variety of fellows with varying degrees of knowledge and expe