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Feeding and Impact on Glucose Control

Feeding and Impact on Glucose Control. Rosan Meyer Paediatric Dietitian Dec 2007. Overview. Difference in energy expenditure between a critically ill child and healthy child Gastrointestinal tract and absorption Fat, protein, carbohydrate absorption

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Feeding and Impact on Glucose Control

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  1. Feeding and Impact on Glucose Control Rosan Meyer Paediatric Dietitian Dec 2007

  2. Overview • Difference in energy expenditure between a critically ill child and healthy child • Gastrointestinal tract and absorption • Fat, protein, carbohydrate absorption • Glucose from the gut to maintaining blood glucose • The role of insulin and glucagon • The stress response and glucose metabolism • Starvation and/or stress and glucose levels • Route of Feeding • Impact of Nutritional Support on Glucose levels

  3. The critically Ill child versus the healthy child Spontaneous breathing and eating food No growth Ventilated and fed artificially Diagnosis and disease severity Active Environmental factors Thermoneutral environment Not active Growth Parental consent obtained

  4. The Gastrointestinal Tract and Absorption Alcohol/medication H2O, Na, Vit K Most nutrients: Protein, CHO, Fat

  5. Absorption of Nutrients

  6. Glucose Absorption

  7. The Role of Insulin and Glucagon Insulin and glucagon work synergistically to keep blood glucose concentration normal

  8. What about Glucose Metabolism in the Critically Ill Child

  9. The RESULT !!!! ↓GLUCOSE USE! ↑ GLUCOSE SYNTHESIS GLUCOSE

  10. Other Factors that Impact on Glucose Levels SIZE MATTERS!!!!

  11. Stages of Starvation

  12. Start Feeding! Nurse !!

  13. Physiological Impact of Starvation +/- Stress

  14. Route of Feeding • Nasogastric • Continuous • boluses • Nasojejunal • Continuous • Parenteral • Cyclical • Continuous

  15. When and what route • First 24 hours NBM Parenteral Nutrition Enteral Nutrition • Attempt gastric feeding • Ensure maintenance: saline dextrose/ dextrose

  16. 24-48 hours NBM Enteral Parenteral • Insert NJ if possible • Change feed • 10% Dextrose (drugs, IV) Eg: 10kg child on 100% fluid

  17. > 72 Hours NBM Enteral Nutrition Parenteral Nutrition • >2 days (neonates) PN indicated • > 4 days(infants and young children) PN indicated • >7 days in older children and teenagers

  18. Nutritional Support and Glucose Control • Route of feeding • Feeding break/ no feeding break? • Bolus/ Continuous Feeding • Parenteral Nutrition • Central line: much higher glucose • Peripheral line: max 12.5% • Type of feed, especially additions • Maxijul/ Duocal • Medication mixed with dextrose

  19. Summary • Glucose metabolism is dependant on insulin and glucagon • Hormone levels affected by the stress response • Starvation can make it worse • Feeding can affect (improve) glucose levels

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