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Hyperglycemia in the critically ill.

Colleen Digman1, Dara Borto, Stanley A Nasraway

  • 1Department of Medicine, Tufts-New England Medical Center and the Tufts University School of Medicine, Boston, Massachusetts 02111, USA.

Nutrition in Clinical Care : an Official Publication of Tufts University
|July 15, 2005
PubMed
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Stress hyperglycemia in critically ill patients is linked to worse outcomes. Intensive insulin therapy to normalize blood glucose (euglycemia) can reduce mortality and morbidity in these patients.

Area of Science:

  • Critical Care Medicine
  • Endocrinology
  • Metabolic Disorders

Background:

  • Hyperglycemia (high blood sugar) is common in acutely ill patients, often considered a stress response.
  • Historically, treatment was delayed until blood glucose levels exceeded 200-250 mg/dL.
  • Emerging evidence links hyperglycemia to adverse outcomes in intensive care unit (ICU) patients.

Purpose of the Study:

  • To review the association between hyperglycemia and poor outcomes in critically ill patients.
  • To discuss the mechanisms contributing to hyperglycemia in this population.
  • To highlight the benefits of intensive insulin therapy for managing hyperglycemia.

Main Methods:

  • Review of recent evidence and studies on hyperglycemia in medical and surgical ICUs.

Related Experiment Videos

  • Analysis of physiological mechanisms causing hyperglycemia, including increased gluconeogenesis and insulin resistance.
  • Examination of studies evaluating intensive insulin therapy for glycemic control.

    • Main Results:

    • Hyperglycemia in critically ill patients is associated with worse clinical outcomes.
    • Potential mechanisms include mitochondrial dysfunction, glucose toxicity, and immune impairment.
    • Intensive insulin therapy to achieve euglycemia has been shown to reduce mortality and morbidity.

    Conclusions:

    • Hyperglycemia in critically ill patients is not merely a stress response but a detrimental condition.
    • Understanding the mechanisms of hyperglycemia is crucial for effective management.
    • Intensive insulin therapy is a key intervention to improve outcomes in critically ill patients with hyperglycemia.
    • Identifying and managing contributing factors like medications and nutrition is also vital.