Stress-Induced Hyperglycemia: Consequences and Management

Abstract

Hyperglycemia during stress is a common occurrence seen in patients admitted to the hospital. It is defined as a blood glucose level above 180mg/dl in patients without pre-existing diabetes. Stress-induced hyperglycemia (SIH) occurs due to an illness that leads to insulin resistance and decreased insulin secretion. Such a mechanism causes elevated blood glucose and produces a complex state to manage with external insulin. This article compiles various studies to explain the development and consequences of SIH in the critically ill that ultimately lead to an increase in mortality while also discussing the dire impact of SIH on certain acute illnesses like myocardial infarction and ischemic stroke. It also evaluates multiple studies to understand the management of SIH with insulin and proper nutritional therapy in the hospitalized patients admitted to the Intensive care unit (ICU) alongside the non-critical care unit. While emphasizing the diverse effects of improper control of SIH in the hospital, this article elucidates and discusses the importance of formulating a discharge plan due to an increased risk of type 2 diabetes in the recovered.

Keywords: admission hyperglycemia; continuous glucose monitoring systems; critically ill patients; de novo diabetes mellitus; diabetes and hospitalar hyperglycemia; in-hospital mortality; insulin in icu; insulin protocol; nutrition in critical care; stress hyperglycemia.

Figure 1. Pathophysiology of Stress Hyperglycemia

TNF-α: Tumor necrosis factor-α; IL-6: Interleukin-6; IL-1: Interleukin-1; FOXO: Forkhead Box O Image credit: Deepanjali Vedantam

Figure 2. Protocol for Intravenous Insulin Infusion

Image credit: Deepanjali Vedantam

Figure 3. Insulin Administration in the Hospital

Image credit: Deepanjali Vedantam