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Use of Continuous Glucose Monitoring to Assess Parenteral Nutrition–Induced Hyperglycemia in an Adult Patient With Severe COVID‐19
Author(s) -
Chow Kenneth W.,
Kelly Danielle J.,
Gupta Rajarsi,
Miller Joshua D.
Publication year - 2021
Publication title -
journal of parenteral and enteral nutrition
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.935
H-Index - 98
eISSN - 1941-2444
pISSN - 0148-6071
DOI - 10.1002/jpen.2032
Subject(s) - medicine , hypoglycemia , covid-19 , intensive care unit , insulin , intensive care medicine , parenteral nutrition , regimen , emergency medicine , pandemic , continuous glucose monitoring , pediatrics , disease , infectious disease (medical specialty) , glycemic
Many patients admitted to the intensive care unit (ICU) are acutely malnourished and often require aggressive and early nutrition support with parenteral nutrition (PN). However, PN‐induced hyperglycemia is a predictor of hospital mortality and is associated with increased length of stay. Elevated blood glucose in hospitalized patients with coronavirus disease 2019 (COVID‐19) is also associated with increased mortality. Real‐time continuous glucose monitoring (rtCGM) is primarily used in the outpatient setting, but there is rapidly growing interest in its applicability to help treat dysglycemia in critically ill patients, especially during the ongoing COVID‐19 pandemic. We assessed the use of rtCGM data (Dexcom G6) in a 58‐year‐old male admitted to the ICU for severe COVID‐19 infection, who developed PN‐induced hyperglycemia with markedly elevated total daily insulin requirements as high as 128 units. rtCGM was used to safely titrate insulin infusion and monitor glucose levels. No episodes of hypoglycemia were observed, despite an extremely aggressive insulin regimen. This case demonstrates the potential utility of rtCGM in the critical care setting and highlights its potential to help conserve personal protective equipment and minimize unnecessary staff exposure in the setting of COVID‐19.