Surgical Critical Care: Stress-Induced Hyperglycemia

Stress-Induced Hyperglycemia

Causes

  • Surgery
  • Critical Illness
  • Trauma
  • Burns
  • Any Other Cause of Significant Stress

Pathophysiology

  • Primary Factors:
    • Increased Gluconeogenesis
    • Hepatic Insulin Resistance
  • Release of Counterregulatory Hormones
  • Relative Overall State of Insulin Resistance
  • Impaired Glucose Transporter (GLUT)-4 Receptor Translocation
  • Impaired Skeletal Muscle Uptake of Glucose

Counterregulatory Hormones

  • Glucagon
  • Cortisol – Increased Gluconeogenesis & Protein Catabolism
  • Growth Hormone – Inhibits Insulin Receptors
  • Catecholamines – Promote Hepatic Glucose Production
  • Cytokines (IL-1, IL-6 & TNF-Alpha) – Promote Hepatic Glucose Production

Complications

  • Cardiac Complication
  • Sepsis
  • Renal Failure
  • Death

Management

  • Primary Treatment: Insulin
    • Generally Start with a Sliding-Scale Regimen
    • May Require Insulin Infusion
  • Target Blood Glucose: 140-180 mg/dL
    • *NICE SUGAR Trial – Found Increased Mortality with Intensive Insulin Therapy (Goals 81-108 mg/dL)