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The Relationship of Insulin Production to Glucose Metabolism in Severe Sepsis

Michael S. Dahn, MD; Lloyd A. Jacobs, MD; Stuart Smith, PhD; Bijaya Hans, MD; M. Patricia Lange, BSN; Robert A. Mitchell, PhD; John R. Kirkpatrick, MD
Arch Surg. 1985;120(2):166-172. doi:10.1001/archsurg.1985.01390260036006.
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• 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 μU/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 μU/cc) relative to injured patients (77 μU/cc). These findings indicate that insulin suppression is evident in sepsis even in the absence of shock and suggest that sepsisrelated basal hyperglycemia does not appear to be associated with peripheral insulin resistance.

(Arch Surg 1985;120:166-172)

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