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Updated: Feb 25, 2026

Improving IV Insulin Administration in a Community Hospital
Published on: June 11, 2012
Hyperglycaemia in critically ill patients: the immune system's sweet tooth
Gustav van Niekerk1, Tanja Davis2, Anna-Mart Engelbrecht2
1Department of Physiological Sciences, Stellenbosch University, Private Bag X1, Matieland, Stellenbosch, 7600, South Africa. gustav.v.niekerk@gmail.com.
Abstract:
There is an ongoing debate regarding the efficacy of glycaemic control in critically ill patients. Here we briefly highlight the key function of elevated glucose in critically ill patients, namely, to enable elevation of aerobic glycolysis in rapidly dividing cells. In particular, aerobic glycolysis provides metabolic intermediates necessary for expansion of biomass in immune cells and promotion of tissue repair. Furthermore, we emphasise that insulin may inhibit autophagy, a cell survival process used in the bulk degradation of cellular debris and damaged organelles. These observations provide a rational basis for tolerating elevated glucose levels in certain critically ill patients.
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