Q Why is it so important to treat hyperglycemia in critically ill patients?

A Diane Byrum, RN, MSN, CCRN, CCNS, replies:

The stress of critical illness often leads to hyperglycemia, even in patients with no history of diabetes mellitus. Metabolic homeostasis is significantly altered with injuries, infections, invasive procedures, and medications (corticosteroids). Hyperglycemia is stimulated by the release of counterregulatory hormones such as epinephrine, cortisol, growth hormone, and glucagons. Along with the hyperglycemic effect of critical illness, it is believed that many patients are also insulin resistant. During this altered metabolic state, increased glyconeogenosis occurs as the body attempts to meet the metabolic demands of the inflammatory response. As glucose levels rise, increasing amounts of insulin are released. This increased endogenous insulin is not effective in decreasing the blood sugar levels.

In response to the increased need for energy, the endothelial cells dilate to allow nutrients and oxygen to enter...

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