RT Book, Section A1 Bassily-Marcus, Adel A1 Khachaturova, Inga A2 Oropello, John M. A2 Pastores, Stephen M. A2 Kvetan, Vladimir SR Print(0) ID 1136418426 T1 Controversies: Is Glucose Control Relevant? T2 Critical Care YR 1 FD 1 PB McGraw-Hill Education PP New York, NY SN 9780071820813 LK accessmedicine.mhmedical.com/content.aspx?aid=1136418426 RD 2024/03/28 AB Virtually all adult medical ICU patients experience at least 1 blood glucose value above the normal fasting level (110 mg/dL).1 The stress of critical illness promotes a state of insulin resistance which is characterized by increased hepatic gluconeogenesis and glycogenolysis, impaired peripheral glucose uptake, and higher circulating concentrations of insulin. There is upregulation of hepatic glucose production triggered by elevated levels of cytokines and counterregulatory hormones such as glucagon, cortisol, growth hormone, and catecholamines. These metabolic disturbances together with common ICU treatments such as corticosteroids, sympathomimetic agents, and glucose-containing infusions explain the frequently observed phenomenon of hyerglycemia irrespective of the disease, diabetes mellitus.