Stress hyperglycemia 1764060 221116074 2008-06-23T03:06:48Z DOI bot 6652755 Citation maintenance. Initiated by [[User:Fconaway|Fconaway]]. You can [[WP:DOI|use this bot]] yourself! Please [[User:DOI_bot/bugs|report any bugs]]. '''Stress hyperglycemia''' (also called '''stress diabetes''' or '''diabetes of injury''') is a medical term referring to transient elevation of the blood [[glucose]] due to the [[stress (medicine)|stress]] of illness. It usually resolves spontaneously, but must be distinguished from various forms of [[diabetes mellitus]]. It is often discovered when routine blood chemistry measurements in an ill patient reveal an elevated blood glucose. Blood glucose can be assessed either by a bedside ‘fingerstick’ [[glucose meter]] or plasma glucose as performed in a laboratory (the latter being more efficacious). A retrospective cohort study by the Mayo Clinic held that bedside glucometry was a reliable estimate of plasma glucose with a mean difference of 7.9 mg/dL, but still may not coincide with every individual.<ref name="Mayo2005">{{cite journal |author=Finkielman J, Oyen L, Afessa B |title=Agreement between bedside blood and plasma glucose measurement in the ICU setting |journal=Chest |volume=127 |issue=5 |pages=1749–51 |year=2005 |pmid=15888855 |doi=10.1378/chest.127.5.1749}}</ref> The glucose is typically in the range of 140-300 mg/dl (7.8-16.7 mM) but occasionally can exceed 500 mg/dl (28 mM), especially if amplified by drugs or intravenous glucose. The blood glucose usually returns to normal within hours unless predisposing drugs and intravenous glucose are continued. Stress hyperglycemia is especially common in patients with hypertonic [[dehydration]] and those with elevated [[catecholamine]] levels (e.g., after [[emergency department]] treatment of acute [[asthma]] with [[epinephrine]]). [[Steroid diabetes]] is a specific and prolonged form of stress hyperglycemia. In some people, stress hyperglycemia may indicate a reduced insulin secretory capacity or a reduced sensitivity, and is sometimes the first clue to incipient diabetes. Because of this, it is occasionally appropriate to perform diabetes screening tests after recovery from an illness in which significant stress hyperglycemia occurred. ==Treatment== One of the most sweeping changes in [[intensive care unit]] (ICU) and post-surgical care in recent years is the trend toward more aggressive treatment of stress-induced hyperglycemia.<ref name="survivingsepsis">Dellinger RP, Carlet JM, Masur H, et al. Surviving Sepsis Campaign guidelines for management of severe sepsis and septic shock. ''Crit Care Med''. 2004;32:858-873. PMID 15090974</ref> A number of research studies have demonstrated that even mildly elevated blood glucose levels (110 mg/dL or 6.1 mmol/L) in a hospital intensive care unit (ICU) can measurably increase the morbidity and mortality of such patients. According to a [[randomized control trial]] (RCT) of over 1500 surgical ICU patients, controlling patients’ blood glucose below 110 mg/dL or 6.1 mmol/L significantly decreased mortality from 8% with conventional treatment to 4.6%, and also decreased morbidity from [[sepsis|bloodstream infections]] by 46%, [[acute renal failure]] requiring dialysis or hemofiltration and [[critical illness polyneuropathy]].<ref name="Vandenberghe2001">Van den Berghe G, Wouters P, Weekers F et al. Intensive insulin therapy in the critically ill patients. ''N Engl J Med''. 2001;345(19):1359-67. PMID 11794168</ref> A subsequent RCT of 1200 medical ICU patients found that intensive insulin therapy significantly reduced morbidity but not mortality among all patients in the medical ICU.<ref name="Vandenberghe2006">Van den Berghe G, Wilmer A, Hermans G et al. Intensive insulin therapy in the medical ICU. ''N Engl J Med''. 2006;354(5):449-61. PMID 16452557</ref> On the other hand, several studies failed to show benefit or demonstrated harmful effects (mainly from [[hypoglycemia]]) of intensive insulin therapy in critically ill patients.<ref name="NEJM2008">Brunkhorst FM, Engel C, Bloos F et al. Intensive insulin therapy and pentastarch resuscitation in severe sepsis. ''N Engl J Med''. 2008;358(2):125-39. PMID 18184958</ref> ==References== <references/> [[Category:Metabolic disorders]] [[Category:Nutrition]]