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The Role of Insulin and Blood Glucose Control

  • Conference paper
Mechanisms of Sepsis-Induced Organ Dysfunction and Recovery

Part of the book series: Update in Intensive Care and Emergency Medicine ((UICMSOFT,volume 44))

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Conclusion

Hyperglycemia in critically ill patients is a result of an altered glucose metabolism. Apart from the upregulated glucose production (both gluconeogenesis and glycogenolysis), glucose uptake mechanisms are also affected during critical illness and contribute to the development of hyperglycemia. The higher levels of insulin, impaired peripheral glucoseuptake and elevated hepatic glucose production reflect the development of insulin resistance during critical illness.

Hyperglycemia in critically ill patients has been associated with increased mortality. Simply maintaining normoglycemia with insulin therapy improves survival and reduces morbidity in surgical and medical ICU patients, as shown by two large, randomized controlled studies. These results obtained from clinical studies were also confirmed in ‘real-life’ intensive care of a heterogeneous patient population admitted to a mixed medical/surgical ICU.

Prevention of glucose toxicity by strict glycemic control appears to be crucial, although other metabolic and non-metabolic effects of insulin, independent of glycemic control, may contribute to the clinical benefits.

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Authors and Affiliations

  1. Department of Intensive Care Medicine, Katholieke Universiteit Leuven, Herestraat 49, 3000, Leuven, Belgium

    L. Langouche, I. Vanhorebeek & G. Van den Berghe

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  1. L. Langouche
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  2. I. Vanhorebeek
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  3. G. Van den Berghe
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Editors and Affiliations

  1. Health Sciences Center, Division Pulmonary & Critical Care Medicine, University of Colorado, E. Ninth Avenue 4200, 80262, Denver, CO, USA

    Edward Abraham MD

  2. Bloomsbury Institute of Intensive Care, Division Medicine, University College Hospital, Gower Street, WC1E 6BT, London, UK

    Mervyn Singer MD

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Langouche, L., Vanhorebeek, I., Van den Berghe, G. (2007). The Role of Insulin and Blood Glucose Control. In: Abraham, E., Singer, M. (eds) Mechanisms of Sepsis-Induced Organ Dysfunction and Recovery. Update in Intensive Care and Emergency Medicine, vol 44. Springer, Berlin, Heidelberg . https://doi.org/10.1007/3-540-30328-6_20

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  • DOI: https://doi.org/10.1007/3-540-30328-6_20

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