Insulin resistance and protein catabolism in critically ill patients

Hyperglycemia is a frequently observed phenomenon in critically ill patients, affecting numerous patients without a history of impaired glucose tolerance or diabetes. During critical illness, hyperglycemia may result from decreased peripheral glucose uptake and/or utilisation in presence of normal or elevated plasma insulin levels (peripheral insulin resistance) as well as an increase in hepatic glucose production due to augmented glycogenolysis and gluconeogenesis resulting from stress and/or central (hepatic) insulin resistance. As there are a number of factors that cause or aggravate hyperglycemia/insulin resistance during the intensive care unit (ICU) stay, a multifactorial etiology is likely. Furthermore, animal models of sepsis suggest a decrease in anabolic insulin signalling within skeletal muscle. © Georg Thieme Verlag KG Stuttgart - New York.