Stress-hyperglycemia, insulin and immunomodulation in sepsis

Intensive Care Med. 2004 May;30(5):748-56. doi: 10.1007/s00134-004-2167-y. Epub 2004 Feb 26.


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.

Publication types

  • Review

MeSH terms

  • Critical Care
  • Glucose / metabolism*
  • Humans
  • Hydrocortisone / metabolism
  • Hyperglycemia / drug therapy
  • Hyperglycemia / etiology*
  • Hyperglycemia / metabolism
  • Insulin / immunology
  • Insulin / therapeutic use*
  • Insulin Resistance
  • Sepsis / immunology
  • Sepsis / mortality
  • Sepsis / physiopathology*
  • Stress, Physiological / complications
  • Stress, Physiological / metabolism*


  • Insulin
  • Glucose
  • Hydrocortisone