Skip to main content
SpringerLink
Log in

Stress Hyperglycemia and Glycemic Control

  • Chapter
  • First Online:
Handbook of Evidence-Based Critical Care

  • 2618 Accesses

Abstract

Stress hyperglycemia is common in critically ill and injured patients and is a component of the “fight-and-flight” response. Until recently, stress hyperglycemia was considered a beneficial adaptive response, with the raised blood glucose providing a ready source of fuel for the brain, skeletal muscle, heart, and other vital organs at a time of increased metabolic demand. However, retrospective studies in patients undergoing cardiac surgery suggested that perioperative hyperglycemia was associated with an increased risk of postoperative infections and increased mortality.1–3 Furthermore, these studies suggested that control of blood glucose reduced these complications. Following the first Leuven Intensive Insulin Therapy Trial in 2001, “tight glucose control” became regarded as the standard of care in all ICU patients around the world.4

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 44.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Furnary AP, Wu Y. Clinical effects of hyperglycemia in the cardiac surgery population: the Portland Diabetic Project. Endoc Pract. 2006;12(Suppl) 3:22–26.

    Google Scholar 

  2. Furnary AP, Wu Y. Eliminating the diabetic disadvantage: the Portland diabetic project. Semin Thorac Cardiovasc Surg. 2006;18:302–308.

    Article  PubMed  Google Scholar 

  3. Zerr KJ, Furnary AP, Grunkemeier GL, et al. Glucose control lowers the risk of wound infection in diabetics after open heart operations. Ann Thorac Surg. 1997;63:356–361.

    Article  PubMed  CAS  Google Scholar 

  4. van den Berghe G, Wouters P, Weekers F, et al. Intensive insulin therapy in critically ill patients. N Engl J Med. 2001;345:1359–1367.

    Article  PubMed  Google Scholar 

  5. Garber AJ, Moghissi ES, Bransome ED Jr, et al. American College of Endocrinology position statement on inpatient diabetes and metabolic control. Endoc Pract. 2004;10:77–82.

    Google Scholar 

  6. Critchell C, Savarese V, Callahan A, et al. Accuracy of bedside capillary blood glucose measurements in critically ill patients. Intensive Care Med. 2007;33:2079–2084.

    Article  PubMed  CAS  Google Scholar 

  7. Kanji S, Buffie J, Hutton B, et al. Reliability of point-of-care testing for glucose measurement in critically ill adults. Crit Care Med. 2005;33:2778–2785.

    Article  PubMed  Google Scholar 

  8. van den Berghe G, Wilmer A, Hermans G, et al. Intensive insulin therapy in the medical ICU. N Engl J Med. 2006;354:449–461.

    Article  PubMed  Google Scholar 

  9. Devos P, Preiser JC, Melot C. Impact of tight glucose control by intensive insulin therapy on ICU mortality and the rate of hypoglycaemia: final results of glucotrol [European society of Intensive Care Medicine 20th Annual Congress abstract 0735]. Intensive Care Med. 2007;33(suppl 2):S189.

    Google Scholar 

  10. Brunkhorst FM, Engel C, Bloos F, et al. Intensive insulin therapy and pentastarch resuscitation in severe sepsis. N Engl J Med. 2008;358:125–139.

    Article  PubMed  CAS  Google Scholar 

  11. De La Rosa GD, Donado JH, Restrepo AH, et al. Strict glycemic control in patients hospitalized in a mixed medical and surgical intensive care unit: a randomized clinical trial. Crit Care. 2008;12:R120.

    Article  Google Scholar 

  12. Arabi Y, Dabbagh OC, Tamim HM, et al. Intensive versus conventional insulin therapy: A randomized controlled trial in medical and surgical critically ill patients. Crit Care Med. 2008;36:3190–3197.

    Article  PubMed  CAS  Google Scholar 

  13. Finfer S, Chittock DR, Su SY, et al. Intensive versus conventional glucose control in critically ill patients. The NICE-Sugar Study Investigators. N Engl J Med. 2009;360:1283–1297.

    Article  PubMed  Google Scholar 

  14. Oddo M, Schmidt M, Carrera E, et al. Impact of tight glycemic control on cerebral glucose metabolism after severe brain injury: a microdialysis study. Crit Care Med. 2008;36:33233–33238.

    Google Scholar 

  15. Umpierrez GE, Palacio A, Smiley D. Sliding scale insulin use: myth or insanity? Am J Med. 2007;120:563–567.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Pulmonary and Critical Care Medicine, Eastern Virginia Medical School, Norfolk, VA, USA

    Paul Ellis Marik MBBCh, FCP(SA), FRCP(C), FCCP, FCCM, FACP, MD

Authors
  1. Paul Ellis Marik MBBCh, FCP(SA), FRCP(C), FCCP, FCCM, FACP, MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Paul Ellis Marik MBBCh, FCP(SA), FRCP(C), FCCP, FCCM, FACP, MD .

Rights and permissions

Reprints and permissions

Copyright information

© 2010 Springer Science+Business Media, LLC

About this chapter

Cite this chapter

Marik, P.E. (2010). Stress Hyperglycemia and Glycemic Control. In: Handbook of Evidence-Based Critical Care. Springer, New York, NY. https://doi.org/10.1007/978-1-4419-5923-2_39

Download citation

  • DOI: https://doi.org/10.1007/978-1-4419-5923-2_39

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4419-5922-5

  • Online ISBN: 978-1-4419-5923-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation