Increased blood flow by insulin infusion targeting normoglycemia in patients with severe sepsis: friend or foe?

Greet Berghe

doi:10.1186/cc8228

Abstract

A small study in patients with severe sepsis suggested that insulin infused to normalize blood glucose levels increased forearm flow. This clinical observation supports the effect of insulin on the endothelium, as previously shown by in vitro studies and by in vivo animal models of critical illness, but the clinical consequences remain unclear.

Highlights

A small study in patients with severe sepsis suggested that insulin infused to normalize blood glucose levels increased forearm flow
The antagonistic effect between insulin signaling and hyperglycemia on inflammation and blood flow is an interesting one, which is important to take into account when analyzing results of studies on the topic
It may be that a certain threshold of hyperglycemia needs to be avoided in order for insulin to exert a protective effect on the endothelium

Summary

Introduction

A small study in patients with severe sepsis suggested that insulin infused to normalize blood glucose levels increased forearm flow. Žuran and colleagues’ study is an interesting clinical observation made in a difficult setting of clinical practice treating patients with sepsis and organ failure, for which the authors ought to be congratulated.

Results

Conclusion