Hyperglycemia and insulin resistance
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- Hyperglycemia is common following hemorrhage, sepsis, and trauma
- Immediately after injury, the plasma insulin concentration is depressed in relation to the degree of hyperglycemia due to a reduction in beta islet cell sensitivity to glucose mediated by catecholamines, cortisol and increased activity of the sympathetic nervous system
- The persistence of hyperglycemia reflects a resistance of normally insulin sensitive tissues to insulin (particularly muscle); the osmotic effect also mediates part of the fluid shift from intracellular to extracellular
- Glucose metabolism is related to severity of injury and survival; patients with a normal glucose tolerance test suffer much less morbidity than those who have an abnormal glucose tolerance test
- Hyperglycemia is an independent predictor of poor outcome in brain injury ( traumatic, ischemic, hemorrhagic) and intensive insulin therapy in critically ill patients has been associated with outcome improvement ( reduced in-hospital mortality, blood stream infections, acute renal failure, days of mechanical ventilation, and critical-illness polyneuropathy).