Effect of Intravenous Insulin Therapy on Clinical Outcomes in Critically Ill Patients

Pre-Procedural Blood Glucose Levels

“…In the critical care population, hyperglycemia in patients without diabetes is seen by some as a "stress test" denoting the failure of endogenous insulin reserves to adequately control blood glucose (20). Others have postulated that hyperglycemia occurs because of insulin resistance (20). Whether these mechanisms account for hyperglycemia in patients with acute myocardial infarction is uncertain.…”

“…The study by Stolker et al (19) is the first to document an increase in the risk for contrast-induced AKI with progressive elevations of blood glucose levels. Hyperglycemia in patients without diabetes is commonly observed in critically ill patients and occurs in more than 40% of patients without diabetes with acute myocardial infarction (20). The etiology of hyperglycemia in this setting is uncertain but may relate in part to stress-related neurohormonal alterations, including stimulation of catecholamines, activation of the renin-angiotensin-aldosterone system, and expression of various cytokines (20).…”

“…The etiology of hyperglycemia in this setting is uncertain but may relate in part to stress-related neurohormonal alterations, including stimulation of catecholamines, activation of the renin-angiotensin-aldosterone system, and expression of various cytokines (20). In the critical care population, hyperglycemia in patients without diabetes is seen by some as a "stress test" denoting the failure of endogenous insulin reserves to adequately control blood glucose (20). Others have postulated that hyperglycemia occurs because of insulin resistance (20).…”

“…Hyperglycemia in patients without diabetes is commonly observed in critically ill patients and occurs in more than 40% of patients without diabetes with acute myocardial infarction (20). The etiology of hyperglycemia in this setting is uncertain but may relate in part to stress-related neurohormonal alterations, including stimulation of catecholamines, activation of the renin-angiotensin-aldosterone system, and expression of various cytokines (20). In the critical care population, hyperglycemia in patients without diabetes is seen by some as a "stress test" denoting the failure of endogenous insulin reserves to adequately control blood glucose (20).…”

Hyperglycemia-related mortality in critically ill patients varies with admission diagnosis

“…It has been debated whether the mortality risk from hyperglycemia is the same for patients who stay in the ICU for fewer than 3 days compared to individuals with longer ICU stays (46,61,62). This controversy, which has prompted some experts to propose delaying treatment of elevated blood glucose until later in the ICU course (58,62), stems from the findings of Van den Berghe et al who described mortality reduction with normalization of blood glucose in medical ICU patients staying greater than 3 days but not in those whose duration of stay was shorter (15).…”