Insulin therapy with enteral and parenteral nutrition: a consensus statement endorsed by the Swiss Society for Endocrinology and Diabetology and the Swiss Society for Clinical Nutrition and Metabolism

BACKGROUND: Nutritional support with enteral or parenteral nutrition is often required in hospitalised patients and can impair glycaemic control. Despite its clinical importance, practical and uniform recommendations for insulin therapy are lacking. METHODS: The Swiss Society for Endocrinology and Diabetology convened an expert panel to develop consensus guidance on insulin therapy for patients receiving enteral or parenteral nutrition. The working group reviewed available evidence, international guidelines and current practice in Swiss hospitals, and harmonised approaches across regions. The resulting statement provides strategies for insulin dosing in intermittent, continuous and bolus enteral nutrition, as well as parenteral nutrition, primarily for inpatient care, but also applicable to home-based nutritional support. RECOMMENDATIONS: The insulin dose depends on the (known or calculated) basal insulin requirement and the carbohydrate content of the enteral or parenteral nutrition bag. For intermittent enteral nutrition (infused over 12–14 hours), intermediate-acting insulin with a duration of action matching the feeding duration is recommended. For continuous enteral nutrition (over 24 hours), long-acting insulin is preferred. When enteral nutrition is administered as boluses (2–3 hours each), short-acting insulin should be injected before each bolus, similar to prandial dosing with meals. For parenteral nutrition, adding short-acting insulin directly to the parenteral nutrition bag is encouraged, as it helps maintain stable glycaemic control without increasing the risk of hypoglycaemia. Across all modalities, correction insulin should be prescribed according to institutional schemes and individualised requirements, with additional units of correction insulin incorporated into the subsequent day’s basal and (par)enteral nutrition insulin dose. The statement also provides recommendations for glucose monitoring, safe transitions between regimens, and management of unexpected interruptions in nutritional therapy. CONSLUSIONS: This consensus statement, endorsed by the Swiss Society for Endocrinology and Diabetology and the Swiss Society for Clinical Nutrition and Metabolism, represents a nationwide framework for insulin therapy in patients receiving enteral or parenteral nutrition in Switzerland. By standardising insulin use, it aims to enhance safety, reduce glycaemic variability and improve outcomes in hospitalised patients and in those receiving home-based specialised nutritional support.