TY  - JOUR
T1  - INsulin's anabolic effect is influenced by route of administration of nutrients
AU  - Clements RH, Hayes CA, Gibbs E, Geiger J, Laws HL, Long CL
Y1  - 1999/03/01
N1  - 10.1001/archsurg.134.3.274
JO  - Archives of Surgery
SP  - 274
EP  - 277
VL  - 134
IS  - 3
N2  - Objective 
    To determine if the anabolic effects of intravenous insulin on protein kinetics could be exploited in the enterally fed trauma victim.Design 
    Randomized, crossover control protocol.Setting 
    Level I trauma center.Patients 
    Ten trauma patients with an Injury Severity Score higher than 20. Exclusion criteria included diabetes mellitus, pregnancy, steroid use, and aged younger than 18 years or older than 65 years.Interventions 
    Within the first 24 hours of admission to the intensive care unit, each patient had a transpyloric feeding tube inserted radiographically. Enteral nutrition was provided with a protein supplement (Ensure, Ross Laboratories, Columbus, Ohio) and Promod, supplemented with protein powder to supply 1.5 g/kg per day of protein and 156.9 kJ/kg per day. Intravenous insulin was provided at 0.043 U/kg per hour beginning on the second or fourth day.Main Outcome Measures 
    Urinary nitrogen balance and 3-methylhistidine excretion rates were measured at the end of the third and fifth days. Plasma glucose, insulin, and C-peptide levels were obtained at these same times.Results 
    Urinary nitrogen balance was not significantly different with or without the administration of insulin (−4.58±50.1 mg/kg per day vs −9.38±50.9 mg/kg per day, respectively). 3-Methylhistidine excretion rates did not change significantly with or without the administration of insulin (5.77±0.67 µmol/kg per day vs 6.15±0.43 µmol/kg per day, respectively). Serum insulin levels did not differ significantly when exogenous infusions were added (57.8±17.9 µU/mL vs 82.1±44.9 µU/mL), but serum C-peptide levels did decrease significantly when exogenous insulin was added (5.11±3.2 µU/mL vs 10.28±3.5 µU/mL; P=.04). Serum glucose levels decreased significantly when insulin was administered (5.8 ± 0.4 mmol/L [104.6±7.2 mg/dL] vs 7.7 ± 0.4 mmol/L [138.1±7.4 mg/dL]; P=.004).Conclusion 
    The anabolic effect of intravenous insulin on protein kinetics is not evident when nutrition is provided enterally in the trauma victim.
SN  - 0004-0010
M3  - doi: 10.1001/archsurg.134.3.274
UR  - http://dx.doi.org/10.1001/archsurg.134.3.274
ER  -