The relationship of insulin production to glucose metabolism in severe sepsis
M. S. Dahn, L. A. Jacobs, S. Smith, B. Hans, M. P. Lange, R. A. Mitchell and J. R. Kirkpatrick
Basal glucose metabolism was evaluated in eight stable, infected patients
by measuring hepatic glucose production rates in relation to stress
endocrine profile and by comparing these data to five injured, noninfected
patients. All patients exhibited normal total-body oxygen consumptions and
cardiac indices. Fasting basal insulin values were similar in both groups
(6 microU/cc) despite a significantly higher plasma glucose level in septic
patients (106 +/- 14 mg/dL) compared to nonseptic patients (88 +/- 10
mg/dL). Septic patients exhibited splanchnic glucose production and
calculated glucose clearance rates, 53% and 34% higher, than injured
nonseptic patients, respectively. In addition, septic patients exhibited a
decreased pancreatic insulin secretory response to an intravenous glucose
tolerance test as evidenced by a significantly depressed peak insulin value
(17 microU/cc) relative to injured patients (77 microU/cc). These findings
indicate that insulin suppression is evident in sepsis even in the absence
of shock and suggest that sepsis-related basal hyperglycemia does not
appear to be associated with peripheral insulin resistance.
