[fr] À domicile comme à l’hôpital, le patient diabétique est un patient à haut risque de dénutrition. Chez le patient présentant une hyperglycémie
sous nutrition artificielle, l’objectif premier est de couvrir ses besoins calorico-protéiques et d’optimiser en conséquence son traitement antidiabétique.
L’insulinothérapie est le traitement de choix. L’utilisation de produits à faible index glycémique est sans doute préférable, notamment en
complémentation nutritionnelle orale. À apport équivalent, l’apport glucidique parentéral a un effet hyperglycémiant plus important que la voie
orale ou entérale. La prise en charge de l’hyperglycémie au cours de la nutrition artificielle nécessite de définir des objectifs glycémiques adaptés
au patient et à la nutrition artificielle, d’établir des schémas d’insulinothérapie et de fournir des règles d’adaptation précises. La durée d’action
de l’insuline injectée doit correspondre à la durée de passage de la nutrition artificielle. L’usage des échelles insuline-glycémie est à proscrire car
inefficace. Il est nécessaire de former l’équipe soignante. La phase aiguë passée, la pathologie stabilisée, il est parfois possible d’introduire des
antidiabétiques oraux et d’arrêter l’insulinothérapie. Dans ce cas, les règles de prescription de ces médicaments s’appliquent comme chez le patient
nourri oralement. [en] At home as in the hospital, the diabetic patients are at high risk of malnutrition. In patients with hyperglycemia in artificial nutrition, the primary
objective is to to cover their protein needs and their caloric needs and to optimize accordingly the antidiabetic treatment. Insulin therapy is the
treatment of choice. The use of low glycaemic index is probably better, especially for oral supplementation. An equivalent parenteral carbohydrate
intake has a hyperglycaemic effect more important than with the oral or enteral way. The management of hyperglycemia in artificial nutrition
requires defining glycemic goals, tailored to the patient, to the type and the sequences of artificial nutrition, establishing patterns of insulin therapy
and providing accurate adaptation rules. Above the basal requirement, insulin therapy sufficient to meet caloric exposure must be prescribed
appropriate in timing with the artificial nutrition. The use of sliding scale as monotherapy is ineffective. This management requires forming the
nurse team. The acute phase has passed, the disease stabilized, it is sometimes possible to introduce oral antidiabetic drugs and stop insulin. In this
case, we apply the same prescription rules to these drugs as for the patient fed orally.
Thefeld W. [Prevalence of diabetes mellitus in the adult German population]. Gesundheitswesen 1999, 61(Spec no):S85-S89.
Sinclair A.J., Gadsby R., Penfold S., Croxson S.C., Bayer A.J. Prevalence of diabetes in care home residents. Diabetes Care 2001, 24:1066-1068.
Boyko E.J., Fihn S.D., Scholes D., Abraham L., Monsey B. Risk of urinary tract infection and asymptomatic bacteriuria among diabetic and nondiabetic postmenopausal women. Am J Epidemiol 2005, 161:557-564.
Umpierrez G.E., Isaacs S.D., Bazargan N., You X., Thaler L.M., Kitabchi A.E. Hyperglycemia: an independent marker of in-hospital mortality in patients with undiagnosed diabetes. J Clin Endocrinol Metab 2002, 87:978-982.
Benbow S.J., Hoyte R., Gill G.V. Institutional dietary provision for diabetic patients. QJM 2001, 94:27-30.
Staten M.A., Matthews D.E., Bier D.M. Leucine metabolism in type II diabetes mellitus. Diabetes 1986, 35:1249-1253.
Gougeon R., Pencharz P.B., Sigal R.J. Effect of glycemic control on the kinetics of whole-body protein metabolism in obese subjects with non-insulin-dependent diabetes mellitus during iso- and hypoenergetic feeding. Am J Clin Nutr 1997, 65:861-870.
Castaneda C., Bermudez O.I., Tucker K.L. Protein nutritional status and function are associated with type 2diabetes in Hispanic elders. Am J Clin Nutr 2000, 72:89-95.
Saint S., Kaufman S.R., Rogers M.A., Baker P.D., Boyko E.J., Lipsky B.A. Risk factors for nosocomial urinary tract-related bacteremia: a case-control study. Am J Infect Control 2006, 34:401-407.
Overett T.K., Bistrian B.R., Lowry S.F., Hopkins B.S., Miller D., Blackburn G.L. Total parenteral nutrition in patients with insulin-requiring diabetes mellitus. J Am Coll Nutr 1986, 5:79-89.
Cheung N.W., Napier B., Zaccaria C., Fletcher J.P. Hyperglycemia is associated with adverse outcomes in patients receiving total parenteral nutrition. Diabetes Care 2005, 28:2367-2371.
Pasquel F.J., Spiegelman R., McCauley M., Smiley D., Umpierrez D., Johnson R., et al. Hyperglycemia during total parenteral nutrition: an important marker of poor outcome and mortality in hospitalized patients. Diabetes Care 2009, 33:739-741.
Sarkisian S., Fenton T.R., Shaheen A.A., Raman M. Parenteral nutrition-associated hyperglycemia in noncritically ill inpatients is associated with higher mortality. Can J Gastroenterol 2010, 24:453-457.
Monnier L., Colette C., Boniface H. Contribution of postprandial glucose to chronic hyperglycaemia: from the "glucose triad" to the trilogy of "sevens". Diabetes Metab 2006, 32(Spec no2):2S11-6S.
Avignon A., Radauceanu A., Monnier L. Nonfasting plasma glucose is a better marker of diabetic control than fasting plasma glucose in type 2diabetes. Diabetes Care 1997, 20:1822-1826.
Hanefeld M., Fischer S., Julius U., Schulze J., Schwanebeck U., Schmechel H., et al. Risk factors for myocardial infarction and death in newly detected NIDDM: the Diabetes Intervention Study, 11-year follow-up. Diabetologia 1996, 39:1577-1583.
Parks E.J., Hellerstein M.K. Carbohydrate-induced hypertriacylglycerolemia: historical perspective and review of biological mechanisms. Am J Clin Nutr 2000, 71:412-433.
Hofman Z., van Drunen J.D., de Later C., Kuipers H. The effect of different nutritional feeds on the postprandial glucose response in healthy volunteers and patients with type II diabetes. Eur J Clin Nutr 2004, 58:1553-1556.
Elia M., Ceriello A., Laube H., Sinclair A.J., Engfer M., Stratton R.J. Enteral nutritional support and use of diabetes-specific formulas for patients with diabetes: a systematic review and meta-analysis. Diabetes Care 2005, 28:2267-2279.
Craig L.D., Nicholson S., SilVerstone F.A., Kennedy R.D. Use of a reduced-carbohydrate, modified-fat enteral formula for improving metabolic control and clinical outcomes in long-term care residents with type 2diabetes: results of a pilot trial. Nutrition 1998, 14:529-534.
Pohl M., Mayr P., Mertl-Roetzer M., Lauster F., Lerch M., Eriksen J., et al. Glycaemic control in type II diabetic tube-fed patients with a new enteral formula low in carbohydrates and high in monounsaturated fatty acids: a randomised controlled trial. Eur J Clin Nutr 2005, 59:1221-1232.
Vella A., Shah P., Basu R., Basu A., Camilleri M., Schwenk W.F., et al. Effect of enteral vs parenteral glucose delivery on initial splanchnic glucose uptake in nondiabetic humans. Am J Physiol Endocrinol Metab 2002, 283:E259-E266.
Wolfe R.R., Allsop J.R., Burke J.F. Glucose metabolism in man: responses to intravenous glucose infusion. Metabolism 1979, 28:210-220.
Jacot E., Defronzo R.A., Jequier E., Maeder E., Felber J.P. The effect of hyperglycemia, hyperinsulinemia, and route of glucose administration on glucose oxidation and glucose storage. Metabolism 1982, 31:922-930.
Rosmarin D.K., Wardlaw G.M., Mirtallo J. Hyperglycemia associated with high, continuous infusion rates of total parenteral nutrition dextrose. Nutr Clin Pract 1996, 11:151-156.
McMahon M.M. Management of hyperglycemia in hospitalized patients receiving parenteral nutrition. Nutr Clin Pract 1997, 12:35-38.
Herfindal E.T., Bernstein L.R., Wong A.F., Hogue V.W., Darbinian J.A. Complications of home parenteral nutrition. Clin Pharm 1992, 11:543-548.
Williams N., Wales S., Bradley A., Barber D., Shaffer J., Irving M. Long-term glucose homeostasis in patients on home parenteral nutrition. Clin Nutr 1996, 15:141-142.
American Diabetes Association Standards of medical care in diabetes-2011. Diabetes Care 2011, 34(Suppl. 1):S11-S61.
Fatati G., Mirri E., Palazzi M., Vendetti A.L., Pierotti F., Weber P., et al. Insulin glargine in patients with severe hepato-gastroenterology diseases and hyperglycemia receiving parenteral nutrition. Clin Ter 2006, 157:511-515.
