Glargine Insulin vs.Continuous Regular Insulin in Diabetic Surgical Patients Receiving Parenteral Nutrition (GLUCOSE-in-PN)
Glargine Insulin vs.Continuous Regular Insulin in Diabetic Surgical Patients Receiving Parenteral Nutrition (GLUCOSE-in-PN)
Hyperglycemia increases the risk of complications in surgical patients. Focus on poor
 glycemic control as a contributor to adverse outcomes in settings outside the intensive care
 unit (ICU) is often dismissed. Total parenteral Nutrition (TPN) has been used in providing
 surgical patients with nutrition to prevent deterioration of nutritional status. However,
 many diabetic patients receiving TPN develop exaggerated hyperglycemia that requires frequent
 insulin administration via sliding scale. Providing diabetic patient's receiving TPN basal
 insulin is a known strategy to aid in blood sugar control and prevention of high blood sugar
 spikes. Many strategies for basal insulin provision have been utilized clinically during the
 administration of TPN; this includes the incorporation of insulin with TPN solution or
 administration of long acting insulin such as glargine. However, no study has compared any of
 these strategies aiming for selecting the optimum modality for controlling blood glucose in
 diabetic surgical patient's receiving TPN. We will conduct a study to compare the efficacy of
 once daily insulin glargine versus continuous regular insulin incorporated TPN in controlling
 blood glucose in non-critically ill diabetic surgical patients receiving TPN.
Inclusion Criteria:

 -  All adult diabetic patients undergoing abdominal surgery operated by the surgical
 oncology team at KFSH & RC and required TPN therapy are possible subjects of the
 study.

 Exclusion Criteria:

 -  Patients receiving octreotide or immunosuppressive agents including corticosteroids.

 -  Recipient of < 3 units of regular insulin per day via subcutaneous insulin sliding
 scale after the third day of TPN recipient.

 -  Patients with clinically relevant hepatic disease (> three times normal AST and ALT on
 admission to the hospital) or impaired renal function (GFR < 60 ml/min), history of
 diabetic ketoacidosis.

 Patients who get infected while on TPN as reflected with elevation of white blood cells and
 elevated temperature > 37.5 C will be excluded as well.