Continuous Feeding Insulin Injection (CFII): A New Simple Method to Stabilize Severe Glucose Variability and Nutrition Delivery in Critically Ill Patients.

Abstract

This report describes a new, simple, and systematic approach, Continuous Feeding Insulin Injection (CFII), designed to stabilize severe glucose variability and optimize nutritional delivery in critically ill patients when intensive insulin therapy (IIT) alone proves insufficient. Septic patients frequently develop inflammation-induced insulin resistance, resulting in recurrent episodes of hyperglycemia and hypoglycemia. Fever, systemic inflammation, and appetite loss further disrupt glucose homeostasis, complicating nutritional management. CFII integrates two key components: continuous enteral nutrition (CEN) delivered at a fixed rate over 24 hours, based on the patient's metabolic needs, and continuous insulin infusion dynamically adjusted according to frequent or continuous blood glucose monitoring. This approach stabilizes both blood glucose levels and nutritional intake. We present a case of a 65-year-old woman with type 2 diabetes (BMI 21.2 kg/m²) who developed sepsis secondary to pyelonephritis. Despite receiving intensive insulin therapy (IIT), she experienced severe glycemic fluctuations (38-361 mg/dL; mean±SD: 218.6±110.0 mg/dL) and recurrent hypoglycemia, rendering oral intake nearly impossible. CFII was initiated with enteral feeding starting at 1000 kcal/day and gradually increased to 1400 kcal/day, while insulin infusion was dynamically adjusted every three hours. This strategy successfully stabilized severe glucose variability (164.5±35.9 mg/dL), eliminated hypoglycemic episodes, and achieved controlled nutrition delivery. Clinically, similar approaches are presumed to have been used in patients receiving CEN; however, this is the first report to the best of our knowledge to systematically describe CFII as a structured method for glucose and nutritional management in critically ill patients, to propose the term "CFII" and to demonstrate its effectiveness in a patient for whom IIT alone was insufficient. CFII enables nutritional delivery to be tailored to the course of treatment while maintaining stable glycemic control. Its simplicity, practicality, and compatibility with existing hospital systems make CFII an accessible method for broader clinical application. CFII has the potential to improve metabolic outcomes and enhance survival rates in this vulnerable patient population. Further research, including systematic evaluations and randomized controlled trials, is necessary to confirm its efficacy, safety, and applicability across diverse clinical settings.