Use of Continuous Glucose Monitoring to Assess TPN-induced Hyperglycemia in an Adult Patient with Severe COVID-19.

Chow, Kenneth W; Kelly, Danielle J; Gupta, Rajarsi; Miller, Joshua D

Many patients admitted to the intensive care unit (ICU) with are acutely malnourished and often require aggressive and early nutritional support with total parenteral nutrition (TPN). However, TPN-induced hyperglycemia is a predictor of hospital mortality and is associated with increased length of stay. Elevated blood glucose in hospitalized patients with COVID-19 is also associated with increased mortality. Real-time continuous glucose monitoring (rtCGM) is primarily used in the outpatient setting but there is rapidly growing interest in its applicability to help treat dysglycemia in critically ill patients, especially during the ongoing COVID-19 pandemic. We assessed the use of rtCGM data (Dexcom G6) in a 58-year-old male admitted to the ICU for severe COVID-19 infection, who developed TPN-induced hyperglycemia with markedly elevated total daily insulin requirements as high as 128 units. rtCGM was used to safely titrate insulin infusion and monitor glucose levels. No episodes of hypoglycemia were observed despite an extremely aggressive insulin regimen. This case demonstrates the potential utility of rtCGM in the critical care setting and highlights its potential to help conserve personal protective equipment and minimize unnecessary staff exposure in the setting of COVID-19. This article is protected by copyright. All rights reserved.