From the Guidelines
Sepsis is more likely to cause hyperglycemia (high blood sugar) initially, but can also lead to hypoglycemia (low blood sugar) as the condition progresses, and managing blood glucose levels is crucial to improve outcomes. In the context of sepsis, the body's stress response leads to the release of hormones like cortisol, catecholamines, and glucagon, which promote gluconeogenesis and insulin resistance, resulting in elevated blood glucose levels 1. This initial hyperglycemic state is a protective mechanism to ensure vital organs receive adequate glucose during infection. However, as sepsis advances to severe sepsis or septic shock, the risk of hypoglycemia increases due to factors such as depleted glycogen stores, impaired gluconeogenesis, increased peripheral glucose utilization, and alterations in glucose metabolism caused by cytokines. Some key points to consider in managing sepsis-related glucose disturbances include:
- Commencing insulin dosing when consecutive blood glucose levels exceed 180 mg/dL, as recommended by the Surviving Sepsis Campaign guidelines 1
- Targeting an upper blood glucose level of ≤ 180 mg/dL, rather than ≤ 110 mg/dL, to minimize the risk of hypoglycemia while controlling hyperglycemia 1
- Monitoring blood glucose values every 1 to 2 hours until glucose values and insulin infusion rates are stable, then every 4 hours thereafter 1
- Interpreting glucose levels obtained from point-of-care testing of capillary blood with caution, as they may not accurately reflect arterial blood or plasma glucose values 1. Given the potential for both hyperglycemia and hypoglycemia in sepsis, and the importance of glucose control in improving outcomes, close monitoring and appropriate management of blood glucose levels are essential in the care of patients with sepsis.
From the Research
Sepsis and Blood Sugar Levels
- Sepsis is often associated with hyperglycemia (high blood sugar) 2, 3, 4, which can be detrimental to patient outcomes.
- However, some studies suggest that sepsis can also lead to hypoglycemia (low blood sugar) 5, 6, particularly in severe cases.
- The relationship between sepsis and blood sugar levels is complex, and both hyperglycemia and hypoglycemia can have significant impacts on patient outcomes.
Hyperglycemia in Sepsis
- Hyperglycemia is a common feature of sepsis, and maintaining normoglycemia (blood glucose levels <or=110 mg/dL) with intensive insulin therapy has been shown to improve survival and reduce morbidity in critically ill patients 2.
- However, intensive insulin therapy can also increase the risk of hypoglycemia, particularly in patients with sepsis 3, 4.
Hypoglycemia in Sepsis
- Hypoglycemia is less common than hyperglycemia in sepsis, but it can still occur, particularly in severe cases 5, 6.
- Sepsis-associated hypoglycemia on admission has been associated with increased mortality in intensive care unit patients 5.
- Hypoglycemia may be related to increased severity and high mortality in patients with severe sepsis, particularly in those without known diabetes 6.
Glycemic Control in Sepsis
- Daily glycemia variation is more reliable than mean glycemic level in evaluating glucose homeostasis in septic patients 3.
- Prevention of cellular glucose toxicity by strict glycemic control appears to play a predominant role in improving patient outcomes, but other metabolic and non-metabolic, anti-inflammatory effects of insulin may also contribute to clinical benefits 2.