Enteral feeding for adults with diabetes

Hyperglycaemia is a common complication of enteral feeding in adults with diabetes. Enteral feeds with low glycaemic index (GI) are preferred as they have less impact on blood glucose concentrations. If insulin is required to manage the hyperglycaemia, this should be divided into basal (long-acting insulin) and bolus (rapid-acting insulin) doses. Bolus insulin is given every 4 to 6 hours or timed to match feed boluses. Follow local protocols or seek advice from the endocrinology team if available.

A clear plan should be documented for insulin management if enteral feeds are stopped, whether planned or inadvertent (eg a feeding tube is dislodged). If feeds are stopped, rapid-acting insulin should be withheld and intravenous glucose may be required to avoid hypoglycaemia resulting from the long-acting basal insulin. Adults with type 1 diabetes who have their enteral feeds stopped need to continue basal insulin with dose adjustments made to avoid hypoglycaemia.

For detailed information about drug administration in patients with an enteral feeding tube, see the Australian Don’t Rush to Crush Handbook¹.