Hypoglycemia and Hyperglycemia in Critically Ill Cancer Patients

  • Seda Hanife Oguz
  • Ugur Unluturk
  • Sahin Lacin
  • Alper Gurlek
  • Suayib YalcinEmail author
Reference work entry


Advances in cancer therapy and supportive care have led to increased survival of patients with cancer. Hyperglycemia and hypoglycemia, both associated with poor outcome, are glucose metabolism disorders seen frequently in patients with cancer that requires careful management. Hyperglycemia and hypoglycemia can be observed in all types of cancer, although some cancers may increase the risk of these complications. The incidence of hyperglycemia is higher than hypoglycemia. Estimated prevalence of hyperglycemia in nondiabetic critically ill patients is 30–40%, while 12–25% of hospitalized patients are diabetic. Cancer and diabetes are diagnosed in the same individual more frequently than would be expected by chance. Hypoglycemia during critical care has an incidence of 5–19% usually as a result of antidiabetic treatment. Tumor-induced hypoglycemia occurs more rarely and can involve several mechanisms. The American Diabetes Association (ADA) defines hyperglycemia in hospitalized patients as blood glucose levels greater than 140 mg/dl (7.8 mmol/L). Hyperglycemia in critically ill or cancer patients is mostly stress-induced, while hypoglycemia is mostly a consequence of insulin therapy. ADA recommends to initiate insulin treatment in persistent hyperglycemia in critically ill patients at a threshold of 180 mg/dl (10 mmol/L) and to set a target glucose level of 140–180 mg/dl, although tighter glucose targets may be appropriate for certain group of patients (e.g., postoperative care).


Hypoglycemia Hyperglycemia Cancer Critical care Critical illness 


  1. 1.
    Shimabukuro-Vornhagen A, et al. Critical care of patients with cancer. CA Cancer J Clin. 2016;66: 496–517.CrossRefGoogle Scholar
  2. 2.
    Soares M, et al. Characteristics and outcomes of patients with cancer requiring admission to intensive care units: a prospective multicenter study. Crit Care Med. 2010;38(1):9–15.CrossRefGoogle Scholar
  3. 3.
    Magrath I, Litvak J. Cancer in developing countries: opportunity and challenge. J Natl Cancer Inst. 1993;85(11):862–74.CrossRefGoogle Scholar
  4. 4.
    Ahern TP, et al. Plasma C-peptide, mammographic breast density, and risk of invasive breast cancer. Cancer Epidemiol Biomark Prev. 2013;22(10): 1786–96.CrossRefGoogle Scholar
  5. 5.
    Jenab M, et al. Serum C-peptide, IGFBP-1 and IGFBP-2 and risk of colon and rectal cancers in the European prospective investigation into cancer and nutrition. Int J Cancer. 2007;121(2):368–76.CrossRefGoogle Scholar
  6. 6.
    Lattermann R, et al. Integrated analysis of glucose, lipid, and urea metabolism in patients with bladder cancer. Impact of tumor stage. Nutrition. 2003;19(7–8):589–92.CrossRefGoogle Scholar
  7. 7.
    Heber D, et al. Abnormalities in glucose and protein metabolism in noncachectic lung cancer patients. Cancer Res. 1982;42(11):4815–9.PubMedGoogle Scholar
  8. 8.
    Dungan KM, Braithwaite SS, Preiser JC. Stress hyperglycaemia. Lancet. 2009;373(9677):1798–807.CrossRefGoogle Scholar
  9. 9.
    Williams MD, et al. Hospitalized cancer patients with severe sepsis: analysis of incidence, mortality, and associated costs of care. Crit Care. 2004;8(5):R291–8.CrossRefGoogle Scholar
  10. 10.
    Marik PE, et al. Recommendations for the diagnosis and management of corticosteroid insufficiency in critically ill adult patients: consensus statements from an international task force by the American College of Critical Care Medicine. Crit Care Med. 2008;36(6): 1937–49.CrossRefGoogle Scholar
  11. 11.
    Annane D, et al. Hydrocortisone plus fludrocortisone for adults with septic shock. N Engl J Med. 2018;378(9):809–18.CrossRefGoogle Scholar
  12. 12.
    Goldman JW, Mendenhall MA, Rettinger SR. Hyperglycemia associated with targeted oncologic treatment: mechanisms and management. Oncologist. 2016;21(11):1326–36.CrossRefGoogle Scholar
  13. 13.
    Breitbart W, Alici Y. Evidence-based treatment of delirium in patients with cancer. J Clin Oncol. 2012;30(11):1206–14.CrossRefGoogle Scholar
  14. 14.
    Liao TV, Phan SV. Acute hyperglycemia associated with short-term use of atypical antipsychotic medications. Drugs. 2014;74(2):183–94.CrossRefGoogle Scholar
  15. 15.
    Bassi G, Radermacher P, Calzia E. Catecholamines and vasopressin during critical illness. Endocrinol Metab Clin N Am. 2006;35(4):839–57, xCrossRefGoogle Scholar
  16. 16.
    Virizuela JA, et al. Nutritional support and parenteral nutrition in cancer patients: an expert consensus report. Clin Transl Oncol. 2018;20(5):619–29.CrossRefGoogle Scholar
  17. 17.
    Bessell EM, Selby C, Ellis IO. Severe hypoglycaemia caused by raised insulin-like growth factor II in disseminated breast cancer. J Clin Pathol. 1999;52(10): 780–1.CrossRefGoogle Scholar
  18. 18.
    Gosmanov AR, Umpierrez GE. Management of hyperglycemia during enteral and parenteral nutrition therapy. Curr Diab Rep. 2013;13(1):155–62.CrossRefGoogle Scholar
  19. 19.
    van den Berghe G, et al. Intensive insulin therapy in critically ill patients. N Engl J Med. 2001;345(19): 1359–67.CrossRefGoogle Scholar
  20. 20.
    Van den Berghe G, et al. Intensive insulin therapy in the medical ICU. N Engl J Med. 2006;354(5):449–61.CrossRefGoogle Scholar
  21. 21.
    NICE-SUGAR Study Investigators, et al. Intensive versus conventional glucose control in critically ill patients. N Engl J Med. 2009;360(13):1283–97.CrossRefGoogle Scholar
  22. 22.
    Clement S, et al. Management of diabetes and hyperglycemia in hospitals. Diabetes Care. 2004;27(2): 553–91.CrossRefGoogle Scholar
  23. 23.
    Umpierrez GE, Pasquel FJ. Management of inpatient hyperglycemia and diabetes in older adults. Diabetes Care. 2017;40(4):509–17.CrossRefGoogle Scholar
  24. 24.
    Bodnar TW, Acevedo MJ, Pietropaolo M. Management of non-islet-cell tumor hypoglycemia: a clinical review. J Clin Endocrinol Metab. 2014;99(3):713–22.CrossRefGoogle Scholar
  25. 25.
    Farrokhi F, Smiley D, Umpierrez GE. Glycemic control in non-diabetic critically ill patients. Best Pract Res Clin Endocrinol Metab. 2011;25(5):813–24.CrossRefGoogle Scholar
  26. 26.
    McCowen KC, Malhotra A, Bistrian BR. Stress-induced hyperglycemia. Crit Care Clin. 2001;17(1): 107–24.CrossRefGoogle Scholar
  27. 27.
    Wolfe RR. Herman Award Lecture, 1996: relation of metabolic studies to clinical nutrition – the example of burn injury. Am J Clin Nutr. 1996;64(5):800–8.CrossRefGoogle Scholar
  28. 28.
    McGuinness OP, et al. Impact of chronic stress hormone infusion on hepatic carbohydrate metabolism in the conscious dog. Am J Phys. 1993;265(2 Pt 1):E314–22.Google Scholar
  29. 29.
    McGuinness OP, et al. Impact of acute epinephrine removal on hepatic glucose metabolism during stress hormone infusion. Metabolism. 1999;48(7):910–4.CrossRefGoogle Scholar
  30. 30.
    Bennegard K, Lundgren F, Lundholm K. Mechanisms of insulin resistance in cancer associated malnutrition. Clin Physiol. 1986;6(6):539–47.CrossRefGoogle Scholar
  31. 31.
    Meneilly GS, Cheung E, Tuokko H. Altered responses to hypoglycemia of healthy elderly people. J Clin Endocrinol Metab. 1994;78(6):1341–8.PubMedGoogle Scholar
  32. 32.
    Brealey D, Singer M. Hyperglycemia in critical illness: a review. J Diabetes Sci Technol. 2009;3(6):1250–60.CrossRefGoogle Scholar
  33. 33.
    Kong AP, Chan JC. Hypoglycemia and comorbidities in type 2 diabetes. Curr Diab Rep. 2015;15(10):80.CrossRefGoogle Scholar
  34. 34.
    American Diabetes Association. Standards of medical care in diabetes-2017 abridged for primary care providers. Clin Diabetes. 2017;35(1):5–26.CrossRefGoogle Scholar
  35. 35.
    Biolo G, et al. Treating hyperglycemia improves skeletal muscle protein metabolism in cancer patients after major surgery. Crit Care Med. 2008;36(6):1768–75.CrossRefGoogle Scholar
  36. 36.
    Yuan J, et al. Intensive versus conventional glycemic control in patients with diabetes during enteral nutrition after gastrectomy. J Gastrointest Surg. 2015;19(8):1553–8.CrossRefGoogle Scholar
  37. 37.
    COIITSS Study Investigators, et al. Corticosteroid treatment and intensive insulin therapy for septic shock in adults: a randomized controlled trial. JAMA. 2010;303(4):341–8.CrossRefGoogle Scholar
  38. 38.
    Van den Berghe G. Should glucocorticoid-induced hyperglycemia be treated in patients with septic shock? JAMA. 2010;303(4):365–6.CrossRefGoogle Scholar
  39. 39.
    Krinsley JS. Association between hyperglycemia and increased hospital mortality in a heterogeneous population of critically ill patients. Mayo Clin Proc. 2003;78(12):1471–8.CrossRefGoogle Scholar
  40. 40.
    Krinsley JS. Glycemic variability: a strong independent predictor of mortality in critically ill patients. Crit Care Med. 2008;36(11):3008–13.CrossRefGoogle Scholar
  41. 41.
    Krinsley JS. Glycemic variability and mortality in critically ill patients: the impact of diabetes. J Diabetes Sci Technol. 2009;3(6):1292–301.CrossRefGoogle Scholar
  42. 42.
    Lanspa MJ, et al. Moderate glucose control is associated with increased mortality compared with tight glucose control in critically ill patients without diabetes. Chest. 2013;143(5):1226–34.CrossRefGoogle Scholar
  43. 43.
    Barone BB, et al. Long-term all-cause mortality in cancer patients with preexisting diabetes mellitus: a systematic review and meta-analysis. JAMA. 2008;300(23):2754–64.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Seda Hanife Oguz
    • 1
  • Ugur Unluturk
    • 1
  • Sahin Lacin
    • 2
  • Alper Gurlek
    • 1
  • Suayib Yalcin
    • 2
    Email author
  1. 1.Department of Internal Medicine, Division of Endocrinology and MetabolismHacettepe University School of MedicineAnkaraTurkey
  2. 2.Department of Medical OncologyHacettepe University Institute of CancerAnkaraTurkey

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