Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2023 Feb 24;9(3):e14063.
doi: 10.1016/j.heliyon.2023.e14063. eCollection 2023 Mar.

Intensive insulin therapy in sepsis patients: Better data enables better intervention

Ling Wang  1 , Min Wang  1   2 , Jie Du  1   2 , Zhi-Cheng Gong  1   2   3
Affiliations
Review

Intensive insulin therapy in sepsis patients: Better data enables better intervention

Ling Wang et al. Heliyon. .

Abstract

In clinics, sepsis is a critical disease that often develops into shock and multiple organ dysfunction, leading to a serious threat of death. Patients with sepsis are often accompanied by stress hyperglycemia which is an independent risk factor for poor prognosis in sepsis. Thus, the treatment for stress hyperglycemia has attracted more and more attention, among which intensive insulin therapy is widely concerned. However, the benefits and harms of intensive insulin therapy for sepsis patients remain controversial. What the existing literature discusses mostly are the clinical benefit and hypoglycemia risk of intensive insulin therapy, but there is no conclusion on the target range of blood glucose control, the applicable patients, the timing of treatment initiation, and how to avoid the risk. In this study, we have analyzed and summarized the existing literature, hoping to determine the adverse and clinical benefit of intensive insulin therapy in sepsis. And we attempt to assemble better evidence to propose a better recommendation on hyperglycemia intervention for sepsis patients.

Keywords: Benefit; Intensive insulin therapy; Risk; Sepsis; Stress hyperglycemia.

PubMed Disclaimer

Conflict of interest statement

The authors declare no competing interests.

Figures

Image 1
Graphical abstract
Fig. 1
Fig. 1
Mechanism pattern diagram of elevated blood glucose under stress. (1) Metabolic acceleration; (2) Gluconeogenesis; (3) Decreased glucose utilization; (4) Counter-regulatory hormones increase blood glucose; (5) Cytokines decrease glucose uptake. NES: neuroendocrine system; A: adrenaline; NA: noradrenaline; Cr: cortisol; GH: growth hormone; Pro: protein; GNG: gluconeogenesis; Gn: glycogen; Glu: glucose; M ∅: macrophage.
Fig. 2
Fig. 2
The intensive insulin therapy process currently implemented in ICUs of our hospital. BG: blood glucose; iv: intravenous injection; INS: insulin; IH: hypodermic injection; qh: quaque hora/every hour.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Singer M., Deutschman C.S., Seymour C.W., Shankar-Hari M., Annane D., Bauer M., et al. The third international consensus definitions for sepsis and septic shock (Sepsis-3) JAMA. 2016;315(8):801–810. doi: 10.1001/jama.2016.0287. - DOI - PMC - PubMed
    1. Angus D.C., Linde-Zwirble W.T., Lidicker J., Clermont G., Carcillo J., Pinsky M.R. Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care. Crit. Care Med. 2001;29(7):1303–1310. doi: 10.1097/00003246-200107000-00002. - DOI - PubMed
    1. Wang H.E., Shapiro N.I., Angus D.C., Yealy D.M. National estimates of severe sepsis in United States emergency departments. Crit. Care Med. 2007;35(8):1928–1936. doi: 10.1097/01.CCM.0000277043.85378.C1. - DOI - PubMed
    1. Xie J., Wang H., Kang Y., Zhou L., Liu Z., Qin B., et al. The epidemiology of sepsis in Chinese ICUs: a national cross-sectional survey. Crit. Care Med. 2020;48(3):e209–e218. doi: 10.1097/CCM.0000000000004155. - DOI - PubMed
    1. Hirasawa H., Oda S., Nakamura M. Blood glucose control in patients with severe sepsis and septic shock. World J. Gastroenterol. 2009;15(33):4132–4136. doi: 10.3748/wjg.15.4132. - DOI - PMC - PubMed

LinkOut - more resources