Intensive Insulin Therapy and Pentastarch Resuscitation in Sepsis

2018 ◽  
pp. 109-113
Keyword(s):  
Septic Shock ◽  
Severe Sepsis ◽  
Blood Glucose ◽  
Insulin Therapy ◽  
Fluid Resuscitation ◽  
Intensive Insulin Therapy ◽  
Safety And Efficacy ◽  
Glucose Levels ◽  
Blood Glucose Levels ◽  
Ringer’S Lactate

This case focuses on the use of intensive insulin therapy with sepsis by asking the question: What are the safety and efficacy of intensive insulin therapy compared with conventional therapy and hydroxyethyl starch (HES) compared with Ringer’s lactate in patients with severe sepsis or septic shock? This study demonstrated that critically ill patients did not benefit from intensive insulin therapy targeting blood glucose levels of 80–110 mg/dL vs. conventional insulin therapy nor from fluid resuscitation with HES vs. Ringer’s lactate. Neither intensive insulin therapy nor fluid resuscitation with HES is currently recommended in major sepsis guidelines.

IL-6 levels are inversely related to blood glucose levels in severe sepsis and septic shock

2014 ◽  
Vol 219 (4) ◽  
pp. e131-e132 ◽  
Author(s):  
Anja K. Jaehne ◽  
Emanuel P. Rivers ◽  
Ilan S. Rubinfeld ◽  
Matilda M. Horst ◽  
Justin Belsky ◽  
...  
Keyword(s):  
Septic Shock ◽  
Severe Sepsis ◽  
Blood Glucose ◽  
Glucose Levels ◽  
Blood Glucose Levels ◽  
Sepsis And Septic Shock

scholarly journals Regulation of the Somatotropic Axis by Intensive Insulin Therapy during Protracted Critical Illness

2004 ◽  
Vol 89 (7) ◽  
pp. 3105-3113 ◽  
Author(s):  
Dieter Mesotten ◽  
Pieter J. Wouters ◽  
Robin P. Peeters ◽  
Kevin V. Hardman ◽  
Jeff M. Holly ◽  
...  
Keyword(s):  
Blood Glucose ◽  
Critical Illness ◽  
Insulin Therapy ◽  
Critically Ill ◽  
Intensive Insulin Therapy ◽  
Somatotropic Axis ◽  
Glucose Levels ◽  
Blood Glucose Levels ◽  
Igf I ◽  
Serum Gh

Abstract The catabolic state of critical illness has been linked to the suppressed somatotropic GH-IGF-binding protein (IGFBP) axis. In critically ill patients it has been demonstrated that, compared with the conventional approach, which only recommended insulin therapy when blood glucose levels exceeded 12 mmol/liter, strict maintenance of blood glucose levels below 6.1 mmol/liter with intensive insulin therapy almost halved intensive care mortality, acute renal failure, critical illness polyneuropathy, and bloodstream infections. Poor blood glucose control in diabetes mellitus has also been associated with low serum IGF-I levels, which can be increased by insulin therapy. We hypothesized that intensive insulin therapy would improve the IGF-I axis, possibly contributing to the clinical correlates of anabolism. Therefore, this study of 363 patients, requiring intensive care for more than 7 d and randomly assigned to either conventional or intensive insulin therapy, examines the effects of intensive insulin therapy on the somatotropic axis. Contrary to expectation, intensive insulin therapy suppressed serum IGF-I, IGFBP-3, and acid-labile subunit concentrations. This effect was independent of survival of the critically ill patient. Concomitantly, serum GH levels were increased by intensive insulin therapy. The suppression of IGF-I in association with the increased GH levels suggests GH resistance induced by intensive insulin therapy, which was reflected by the decreased serum GH-binding protein levels. Intensive insulin therapy did not affect IGFBP-3 proteolysis, which was markedly higher in protracted critically ill patients compared with healthy controls. Also, intensive insulin therapy did not suppress the urea/creatinine ratio, a clinical correlate of catabolism. In conclusion, our data suggest that intensive insulin therapy surprisingly suppressed the somatotropic axis despite its beneficial effects on patient outcome. GH resistance accompanied this suppression of the IGF-I axis. To what extent and through which mechanisms the changes in the GH-IGF-IGFBP axis contributed to the survival benefit under intensive insulin therapy remain elusive.

scholarly journals Safety and Efficacy of Intensive Insulin Therapy in Critical Neurosurgical Patients

2009 ◽  
Vol 110 (3) ◽  
pp. 611-619 ◽  
Author(s):  
Federico Bilotta ◽  
Remo Caramia ◽  
Francesca P. Paoloni ◽  
Roberto Delfini ◽  
Giovanni Rosa
Keyword(s):  
Overall Survival ◽  
Intensive Care ◽  
Blood Glucose ◽  
Insulin Therapy ◽  
Infection Rate ◽  
Intensive Insulin Therapy ◽  
Glasgow Outcome Scale ◽  
Brain Surgery ◽  
Glucose Levels ◽  
Blood Glucose Levels

Background Intensive insulin therapy to maintain blood glucose at or below 6.11 mM reduces morbidity and mortality after cardiac surgery and morbidity in medical intensive care unit (ICU) patients. The authors investigated the clinical safety and outcome effects of intensive insulin therapy compared to conventional insulin therapy in patients receiving postoperative intensive care after neurosurgical procedures. Methods In this prospective randomized controlled trial, 483 patients undergoing elective or emergency brain surgery were prospectively and randomly assigned either to intensive insulin therapy (241 patients), receiving insulin titrated to maintain blood glucose levels within the range of 4.44-6.11 mM, or to conventional insulin therapy (242 patients), receiving insulin to maintain blood glucose levels below 11.94 mM. Primary endpoint was incidence of hypoglycemia (defined as blood glucose < 2.78 mM). Efficacy measures included the length of ICU stay, infection rate, and 6 months follow-up Glasgow outcome scale score and overall survival. Results Hypoglycemia episodes were more frequent in patients receiving intensive insulin therapy, median (min-max): 8 (0-23) versus 3 (0-4); P < 0.0001. The length of stay in the ICU was shorter (6 vs. 8 days; P = 0.0001), and the infection rate was lower (25.7% vs. 39.3%; P = 0.0018). Glasgow outcome scale score and overall survival at 6 months were similar in the two groups. Conclusions Intensive insulin therapy in patients admitted to a postoperative neurosurgical ICU after brain surgery is associated with iatrogenic hypoglycemia, but it can also reduce the infection rate and shorten the ICU stay.

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