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Adding Insulin to the TPN? What’s old is new again

29 Aug 2021

New guidelines help control blood glucose in patients on PN

By: Matthew Tanner, PharmD, BCPS, Clinical Informatics

A new set of evidence-based guidelines (based on ADA and AACE) has been developed by the Diabetes Steering Committee and approved by P&T to help control blood glucose for patients on Parenteral Nutrition (PN). There’s no increased risk of hypoglycemia, and it involves insulin in the PN bag.

If an adult patient’s blood glucose is high (greater than 180 x2) after starting full dose PN order, insulin can be added to the PN infusion using guidance found at this link: Insulin Dosing for Parenteral & Enteral Feeding Recommendations.

A consultation with the Glycemic management Team (Michelle Grove [APRN] or Sandy Bunn [APRN]) and close collaboration with the floor pharmacist and nurse is recommended to help ensure the insulin is dosed safely and properly monitored.

The second page features recommendations for assisting patients who have hyperglycemia while receiving various enteral feeding schedules (continuous, cycled or bolus), including supplemental doses of insulin to control hyperglycemia.

If you have questions, you can contact Matt Tanner, Sandy Bunn, or Michelle Grove.