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Without prolonged fasting, healthy individuals maintain blood glucose levels above 3.5 mM due to a well-adapted neuroendocrine counterregulatory system that effectively prevents acute hypoglycemia, a potentially life-threatening condition. The primary clinical scenarios for hypoglycemia encompass diabetes treatment, inappropriate production of endogenous insulin or insulin-like substances by tumors, and the use of glucose-lowering agents in non-diabetic individuals. Notably, hypoglycemia in the...
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Diabetes: Management and Pharmacotherapy01:15

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The therapy for diabetes aims to alleviate hyperglycemia-related symptoms, prevent acute metabolic decompensation, and reduce chronic end-organ complications. Glycemic control is evaluated through short-term (self-monitoring, continuous glucose monitoring) and long-term (A1c, fructosamine) metrics, enabling near real-time tracking of blood glucose levels and reflecting glycemic control over specific time frames.
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Glucose Homeostasis: Regulation of Blood Glucose01:02

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Carbohydrates consumed through foods are converted into glucose, a crucial energy source for the body. In the prandial state, high blood glucose levels stimulate the secretion of insulin from the pancreas. Insulin inhibits hepatic glucose production and stimulates glucose uptake and metabolism by muscle and adipose tissue. The excess glucose is converted into glycogen and stored in the liver and muscles.
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Carbohydrate metabolism is a fundamental biochemical process that ensures a constant supply of energy to living cells. The most important carbohydrate is glucose, which can be broken down via glycolysis to enter into the Krebs cycle and eventually lead to the production of ATP through oxidative phosphorylation.
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Insulin is released by beta cells of the pancreas when blood glucose levels are high. It facilitates glucose absorption and utilization in insulin-dependent cells with insulin receptors on their plasma membranes. Insulin promotes glucose uptake by increasing the number of glucose transport proteins in the cell membrane, allowing glucose to enter the cell. As a result, glucose utilization and ATP production are enhanced.
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Insulin-replacement therapy usually includes both long-acting insulin (basal) and short-acting insulin (to cater to postprandial needs). In a diverse group of type 1 diabetes patients, the average daily insulin dose is typically 0.5-0.7 units/kg body weight. However, obese patients and pubertal adolescents may need more due to insulin resistance.
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[Stress hyperglycemia and nutritional therapy].

Youzhong An1

  • 1Department of Critical Care Medicine, Peking University People's Hospital, Beijing 100044, China. Corresponding author: An Youzhong,

Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
|November 21, 2023
PubMed
Summary

Stress can cause high blood glucose (hyperglycemia), potentially harming organs. Nutritional therapy, unlike support, requires metabolic monitoring to manage blood glucose levels effectively, especially in critical illness.

Area of Science:

  • Endocrinology
  • Metabolism
  • Critical Care Medicine

Context:

  • Stress-induced hyperglycemia is a physiological response to severe stress.
  • Elevated blood glucose levels can exceed the renal glucose threshold (approximately 9 mmol/L), leading to glucose leakage.
  • Maintaining blood glucose below 9 mmol/L is crucial for preventing vascular complications and organ hypoperfusion while avoiding hypoglycemia.

Purpose:

  • To differentiate between nutritional support and nutritional therapy in critical care.
  • To emphasize the importance of metabolic monitoring in managing blood glucose levels.
  • To highlight the need for rational adjustments in nutritional interventions for critically ill patients.

Summary:

  • Nutritional therapy, distinct from nutritional support, involves active coordination and modification of pathophysiology.

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  • Metabolic monitoring is essential to prevent metabolite overloading and address deficiencies.
  • The goal is to protect and coordinate organ function through precise nutritional management.

    • Impact:

    • Shifts focus from passive nutritional support to active, monitored nutritional therapy.
    • Improves patient outcomes by optimizing glucose metabolism and organ function.
    • Provides a framework for evidence-based nutritional interventions in critical illness.