INS and diabetes mellitus: Among them, patients receiving total parenteral nutrition (TPN), regardless of a previous history of diabetes (2), have increased insulin resistance due to elevated levels of corticosteroids and catecholamines, which are caused by elevated levels of organismal stress, acute illness or surgery (3, 4); increased supply of carbohydrates (5); the use of exogenous corticosteroids/vasopressor drugs (6, 7); and the loss of insulin-release regulation by incretin hormones (8).