Abstract
Critically ill patients frequently have hyperglycemia. This event may reflect severe
stress with an imbalance between anabolic hormones and catabolic hormones. Alternatively,
it may reflect alterations in either insulin levels or insulin function. Insulin is
a pleiotropic hormone with multiple important metabolic effects. In patients with
sepsis, insulin levels are increased but insulin sensitivity is decreased. However,
there is variability in insulin sensitivity, and this creates variability in glucose
levels and insulin requirements and increases the frequency of hypo- and hyperglycemia.
The factors that influence insulin sensitivity are complex and include inhibition
of tyrosine kinase activity of the beta subunit, increased proteolytic activity resulting
in loss of receptors from the plasma membrane, and possibly the transfer of insulin
receptors into the nucleus where they bind to gene promoters. Better understanding
of the role of insulin in critically ill patients requires prospective studies measuring
insulin levels in various patient groups and the development of a simple measure of
insulin sensitivity.
Key Indexing Terms
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Article info
Publication history
Published online: November 08, 2020
Accepted:
November 6,
2020
Received:
May 27,
2020
Footnotes
Conflicts: None.
Financial support: None.
Identification
Copyright
© 2020 Southern Society for Clinical Investigation. Published by Elsevier Inc. All rights reserved.
