Which feeding approach may promote more steady and predictable blood glucose concentrations in critically ill patients?

• A. Bolus feeding with insulin
• B. Intermittent bolus feeding
• C. No insulin
• D. Continuous infusions of enteral feeding and insulin

Answer: (D)

Maintaining stable glucose in critically ill patients hinges on matching the amount of carbohydrate entering the body with the level of insulin available to process it. Continuous enteral feeding provides a constant glucose supply, so there are no big post-meal spikes. When this is paired with a continuously infused insulin that can be titrated to the steady input, glucose levels stay more flat and predictable. In contrast, bolus or intermittent feeding creates peaks and troughs in glucose that require rapid and variable insulin adjustments, making glycemic control less predictable. Not using insulin allows glucose to drift higher in the face of insulin resistance. So, continuous enteral feeding with an insulin infusion best promotes steady, predictable blood glucose concentrations.