Stress-hyperglycemia, insulin and immunomodulation in sepsis

  • Paul E. Marik
  • Murugan Raghavan


Stress-hyperglycemia and insulin resistance are exceedingly common in critically ill patients, particularly those with sepsis. Multiple pathogenetic mechanisms are responsible for this metabolic syndrome; however, increased release of pro-inflammatory mediators and counter-regulatory hormones may play a pivotal role. Recent data suggests that hyperglycemia may potentiate the pro-inflammatory response while insulin has the opposite effect. Furthermore, emerging evidence suggests that tight glycemic control will improve the outcome of critically ill patients. This paper reviews the pathophysiology of stress hyperglycemia in the critically ill septic patient and outlines a treatment strategy for the management of this disorder.


Insulin Glucose Sepsis Sepsis syndrome Criticalillness Insulin resistance Hyperglycemia 


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Copyright information

© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  • Paul E. Marik
    • 1
  • Murugan Raghavan
    • 2
  1. 1.Department of Critical Care MedicineUniversity of Pittsburgh Medical CenterPittsburghUSA
  2. 2.Conemaugh Memorial Medical CenterJohnstownUSA

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