Abstract
Stress hyperglycemia and diabetes mellitus with myocardial infarction are associated with increased risk for in-hospital mortality, congestive heart failure, or cardiogenic shock. Hyperglycemia triggers free radical generation and suppresses endothelial nitric oxide generation, and thus initiates and perpetuates inflammation. Conversely, insulin suppresses production of tumor necrosis factor-alpha and free radicals, enhances endothelial nitric oxide generation, and improves myocardial function. It is proposed that the balance between insulin and plasma glucose levels is critical to recovery and/or complications that occur following acute myocardial infarction and in the critically ill. Adequate attention should be given to maintaining euglycemia (plasma glucose <or= 110 mg/dl) in order to reduce infarct size and improve cardiac function while using a glucose-insulin-potassium cocktail.
Highlights
Patients with acute myocardial infarction (AMI) exhibit raised blood glucose concentrations [1,2,3]
Therapeutic administration of high doses of insulin results in an accumulation of myocardial glycogen stores and improvement in glucose utilization. This leads to augmented myocardial adenosine triphosphate provision and maintains cellular energy charge during coronary ischemia, resulting in better tolerance to ischemia and improved myocardial protection [60]. It is evident from the preceding discussion that hyperglycemia is harmful whereas insulin treatment is beneficial
Animal studies revealed that hyperglycemia aggravates endotoxin shock and that insulin treatment decreases mortality [64]
Summary
It is evident from the preceding discussion that hyperglycemia is harmful whereas insulin treatment is beneficial. Animal studies revealed that hyperglycemia aggravates endotoxin shock and that insulin treatment decreases mortality [64]. What are the potential mechanisms by which insulin is able to bring about its beneficial actions?. The ability of insulin to enhance endothelial NO synthesis is significant when one considers its beneficial action in AMI, stroke, and critical illness [16,17,59]. Some of the beneficial actions of insulin (and those of the GIK regimen) in various conditions could be attributable to an increase in endothelial. GIK regimen is useful in preserving the myocardium in septicemia and septic shock, and in patients with severe burn injury [16,17], provided that blood glucose levels are maintained at 110 mg/dl or below by employing an adequate insulin dose. Insulin when present in appropriate amounts preserves myocardial integrity and function
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