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Author(s): Elise Mank [sup.1] , Eva F. G. Naninck [sup.1] [sup.2] , Chris H. P. van den Akker [sup.1] , Annemieke C. Heijboer [sup.3] Author Affiliations: (1) Department of Pediatrics-Neonatology, [...], Human milk (HM) contains numerous non-nutritive bioactive factors, amongst which the peptide hormone insulin. HM insulin has been suggested to accelerate intestinal maturation, thereby promoting feeding tolerance. Therefore, recombinant human insulin for enteral administration has been developed which might serve as supplement to HM or formula for preterm infants. However, the natural course of the HM insulin concentration directly following delivery is unknown, which hampers the development of dosage schedules in clinical trials. The aim of this study was to validate a method for insulin determination in small volumes of HM, and to assess the stability of HM insulin. The results showed that the HM insulin concentration can be measured rapidly and reliably by using an automated immunoassay. In addition, HM insulin is stable at 4 °C for at least 72 h, at room temperature for a maximum of 12 h, at -20 °C for at least 2.5 years, and during at least five freeze-thaw cycles.

Introduction Hyperglycemia is associated with increased mortality in patients with specific conditions such as acute myocardial infarction [1], stroke [2, 3], or trauma [4]. In critically ill patients, hyperglycemia is [...], Objective: Intensive insulin therapy reduces mortality in subgroups of intensive care unit (ICU) patients, and awareness of the importance of blood glucose level (BGL) control has increased among ICU physicians and nurses. The impact of insulin treatment strategies on mortality may be influenced by their efficacy in achieving the target BGL range. We assessed the efficacy of an insulin treatment strategy in maintaining BGL within the target range, and we compared ICU mortality in patients who did and did not reach the BGL target. Design: Prospective cohort study. Setting: 12-bed medical ICU in a tertiary teaching hospital. Patients and participants: Adults consecutively admitted over a 9-month period to an ICU where standard care included an insulin treatment strategy aimed at maintaining BGL ≤ 7 mmol/l. Measurements and main results: 105 patients were included. Median SAPS II was 45 (31-54). Failure to control BGL (mean capillary BGL > 7 mmol/l after initial hyperglycemia correction) occurred in 32 patients (31.1%) and was associated with a significant increase in ICU mortality (56.2 vs. 23.3% in patients with successful BGL control). In the multivariate analysis, failure to control BGL independently predicted death in the ICU (OR 5.9, 2.1-16.6, p < 0.001). Conclusions: Failure to control BGL despite intensive insulin therapy was common and independently associated with ICU mortality. Failure to control BGL may considerably affect the overall impact of insulin treatment strategies on mortality. Keywords Hyperglycemia * Insulin * Intensive care unit * Mortality * Critical illness * Treatment failure