Glucose, insulin and other plasma metabolites shortly after injury.

Abstract

SUMMARYA statistical study was made of measurements within 3 h of injury on 533 patients grouped by injury severity using ISS. A scoring system was also used that took account of the number of injuries. Widely accepted hypotheses about the development of hyperglycaemia were not supported. There was evidence of inhibition of glucose metabolism ('insulin resistance'), but none for any particular mechanism. The only factor that was closely related within any group to [glucose]* (plasma glucose concentration) was [lactate], the higher mean value and variance of which after very severe injuries (ISS above 15) could account for much of the higher mean and variance of glucose in this ISS range. At ISS 9-14, up to 1.4 h after injury, only 4% of the variance of glucose could be accounted for by any combination of the concentrations of catecholamines, cortisol, lactate and vasopressin, times of measurement after injury and food intake, and injury severity and number of injuries. There was also no dependence on the part of the body injured.Injury increased the variability of [insulin] less than published statements imply. The increase found was entirely explicable, as expected, by the changes of [glucose] and [adrenaline].

High cortisol levels in hyperglycaemic myocardial infarct patients signify stress hyperglycaemia and predict subsequent normalization of glucose tolerance

“…We were surprised to find, instead, a negative association between illness severity and admission BGL; and no correlation of BGL with cortisol levels. This lack of association between illness severity and admission BGL has been reported by several other studies 21–24 . Further analyses suggested that this paradox could be explained by the nature of the patient cohort in the HI‐5 study.…”

“…This lack of association between illness severity and admission BGL has been reported by several other studies. [21][22][23][24] Further analyses suggested that this paradox could be explained by the nature of the patient cohort in the HI-5 study. Subjects were recruited if they had known diabetes or hyperglycaemia at the time of admission with an AMI.…”

Guidelines for the use of an insulin infusion for the management of hyperglycemia in critically ill patients

“…[Quality of evidence: very low] A hypermetabolic stress response resulting in hyperglycemia is common in the trauma population (39). Hyperglycemia on admission or within the first 2 ICU days may be predictive of poor outcome (longer LOS, more infection) and higher mortality (40)(41)(42).…”

Validation of surrogate indexes of insulin sensitivity in acute phase of myocardial infarction based on euglycemic-hyperinsulinemic clamp

“…These counterregulatory hormones reach peak levels 12-18 h after MI and then decrease during the next 48 h, subsequently returning to basal (pre-MI) levels (8,15). It was consistently observed that the association between ISi clamp and the surrogate indexes was stronger at D6 than at D2.…”