Which strategy is recommended to manage hyperglycemia during TPN?

• A. Slow the infusion rate
• B. Stop the TPN temporarily
• C. Administer insulin using a sliding-scale protocol
• D. Increase the dextrose concentration

Answer: (C)

Controlling the glucose load with insulin while continuing nutrition is the key idea. Total parenteral nutrition provides a steady stream of dextrose, so when blood glucose rises, the most effective way to bring it down and maintain it stays within a target range is to use an insulin sliding-scale protocol. This approach offers rapid, titratable correction based on current glucose readings and allows ongoing management of hyperglycemia as the TPN continues, reducing the risk of large fluctuations in blood sugar.

Slowing or stopping the TPN would interrupt essential nutrition and is not the best long-term strategy unless the situation is dire. Increasing the dextrose concentration would worsen hyperglycemia, not control it. So using insulin in a sliding-scale protocol aligns treatment with the ongoing glucose load from TPN and provides precise control over glucose levels.