First week without IV feed on intensive care results in better blood glucose control

28 September 2023
A large comparative study confirms it is not a good idea to start IV feed too quickly to patients during their first week on intensive care. The need to adjust blood glucose levels with an insuline pump appears less big when patients did not receive IF feed early on.

The new multicentric and randomised study under the supervision of prof. dr. Greet Van den Berghe and prof. dr. Jan Gunst (UZ Leuven) gives hospitals an additional argument not to start IV feed too quickly in patients on intensive care. In 2001, 2006 and 2009 professor Van den Berghe's research team already published studies that showed how important it is to keep the blood glucose levels of patients on intensive care stable: their chance of organ failure and the risk of death on intensive care were significantly smaller when blood glucose levels remained on a normal level. The principle of keeping blood glucose levels on a normal level with close follow-up and an insulin pump was then adopted by quite a number of centred worldwide.  

At UZ Leuven it has become standard practice since 2001 to make sure that critically ill patients have stable and normal blood glucose levels. UZ Leuven has since developed an excellent computer algorithm to keep blood glucose levels normal without low values or big fluctuations in blood glucose.

By not giving artificial nutrition, we see far fewer high spikes in blood sugar levels. This is better for survival and makes for a faster recovery for the patient
prof. dr. Greet Van den Berghe

Fewer fluctuations in blood glucose level

A new study now show that not giving IV feed in the first week of admission on intensive care makes it easier to prevent blood glucose fluctuations. That giving drip feed to critically ill patients in that initial period is not to be recommeded, had already been proven extensively by UZ Leuven studies in 2011 and 2016. UZ Leuven and many other hospitals now wait a week before starten IF feed to patients in intensive care. 

Prof. dr. Greet Van den Berghe, head of the intensive medicine department at UZ Leuven: “However, we do notice there are still hospitals that still give IV feed to critically ill patients during their first week on intensive care. Our new study, carried out in as many as 9,230 patients, gives a convincing additional argument to not do this anymore: the need for follow-up and adjustment of blood glucose level decreases when patients are not given IV feed during the first week. This is only logical: artificial feeding in your bloodstream raises blood sugar levels very much. As a result we need to bring it down again with an insulin drip. If we don't administer artificial feeding in an early stage, we see far fewer high spikes in blood sugar levels. This new study now shows that it therefore also less necessary to strictly normalise blood glucose levels. Not giving IV feed in an early stage prevents very high blood glucose levels, which is better for the patient's recovery and his survival rate.”

The Leuven intensive care specialists also advise against other medication that can severely disrupt blood glucose levels, but confirm that for some patients there is no other way. "If you do have to administer insulin to critically ill patients, has to make sure there are well-trained doctors and nurses that will proceed with extreme care. A good algorithm and a waterproof protocol will make sure blood glucose levels are kept under control and the chance of complications in critically ill patients is kept to a minimum.”  

The study, performed in colloboration with UZ Gent and Jessa Hospital Hasselt was recently published in the New England Journal Of Medicine.

Last edit: 12 January 2024