Abstract
Stress response is one of the most important host defense mechanisms for insults. Stress-induced hyperglycemia is caused by increased glycolysis and gluconeogenesis, impaired glucose use and decreased insulin secretion. Three sets of data appeared almost simultaneously, thus drawing attention to the control of hyperglycemia. First, high glucose levels resulted in inflammatory and oxidative stress. Second, insulin was found to suppress reactive oxygen species (ROS) generation and activation of the inflammatory process. Third, intensive insulin therapy and glucose control in a critical care setting reduced mortality and morbidity. However, the NICE SUGAR study reported intensive insulin therapy might actually increase mortality. Autophagy is a self-degradative process that is important for balancing sources of energy in response to nutrient deprivation stress. Excessive up-regulated autophagy may induce cell death that is different from apoptosis and necrosis. These observations generated considerable discussion about the wisdom of tight glucose control and nutritional management in critically ill patients.
