Final answer:
For a critically ill hyperglycemic patient with insulin dependent diabetes receiving enteral nutrition, a continuous IV insulin infusion is the ideal management approach. It provides rapid and adjustable dosing to manage fluctuating blood glucose levels and prevent hypoglycemia.
Step-by-step explanation:
A critically ill hyperglycemic patient with a history of insulin dependent diabetes receiving continuous enteral nutrition should optimally be managed with a continuous IV insulin infusion. This is because such patients require careful and constant adjustment of insulin levels that can't effectively be achieved with basal/bolus subcutaneous insulin or oral glucose-lowering agents. Injections of insulin in insulin-dependent diabetes mellitus (IDDM) help lower blood sugar levels by facilitating glucose uptake by the cells. However, with continuous enteral feeding, blood glucose levels can fluctuate unpredictably, thus necessitating the use of a continuously adjustable insulin dosing that can only be provided through an IV infusion.
Continuous IV insulin infusion allows for rapid changes in insulin dosage in response to blood glucose monitoring. This is important for patients with IDDM who are critically ill, as their physiological stress can cause significant variability in their insulin requirements. Adjustment of insulin infusion rates can quickly address both hyperglycemia and prevent hypoglycemia, which can be a side effect of insulin therapy if the dosage is too high.