Nutritional support for the patient with diabetes.

Nutritional support for critically ill patients with diabetes mellitus will be successful when nutrition meets the patient's metabolic needs; blood glucose levels are maintained between 100 and 200 mg/dL; complications of hyperglycemia, sepsis, and hypoglycemia are prevented; insulin dosages take basal metabolic needs, stress level, pharmacologic therapy, and the degree of illness into account; and nutritional support is provided in the least invasive manner possible. Providing nutritional support without adequate glycemic control and appropriate insulin administration is counterproductive for the patient. Careful monitoring of blood glucose and blood chemistries, along with the physical assessment of patients receiving nutritional support, are essential to successful treatment. Further research is necessary to define better which levels of glycemic control are most beneficial for providing optimal nutritional support for critically ill patients with diabetes mellitus.