What is the prevalence of sepsis-induced hypoglycemia (low blood sugar)?

From the Guidelines

Sepsis-induced hypoglycemia is a relatively rare complication, occurring in approximately 1-7% of septic patients, and is more frequently observed in severe sepsis or septic shock cases, particularly in patients with liver dysfunction, malnutrition, or those receiving insulin therapy. The mechanism behind sepsis-induced hypoglycemia involves impaired gluconeogenesis in the liver, increased peripheral glucose utilization, and cytokine-mediated alterations in glucose metabolism. During sepsis, pro-inflammatory cytokines like TNF-α and IL-6 can interfere with normal glucose regulation, while the body's increased metabolic demands deplete glucose stores.

Key Points to Consider

• Healthcare providers should monitor blood glucose levels regularly in septic patients, especially those with risk factors such as liver disease, alcohol use disorder, or malnutrition 1, 2.
• Treatment involves glucose administration (typically D50W or D10W infusion) based on the severity of hypoglycemia, followed by maintenance with dextrose-containing fluids while addressing the underlying sepsis.
• Early recognition is crucial as hypoglycemia in sepsis is associated with worse outcomes and increased mortality.

Glucose Control Recommendations

• A protocolized approach to blood glucose management in ICU patients with sepsis, commencing insulin dosing when two consecutive blood glucose levels are > 180 mg/dL, is recommended 1, 2.
• Blood glucose values should be monitored every 1 to 2 hours until glucose values and insulin infusion rates are stable, then every 4 hours thereafter in patients receiving insulin infusions 1, 2.
• Glucose levels obtained with point-of-care testing of capillary blood should be interpreted with caution because such measurements may not accurately estimate arterial blood or plasma glucose values 1, 2.

Importance of Balanced Nutrition

• Balanced nutrition may be associated with a reduced risk of hypoglycemia 2.
• The continuation of insulin infusions, especially with the cessation of nutrition, has been identified as a risk factor for hypoglycemia 2.

From the Research

Prevalence of Sepsis-Induced Hypoglycemia

• The prevalence of sepsis-induced hypoglycemia varies across studies, with reported rates ranging from 2.6% to 38.2% 3, 4.
• A study published in 2022 found that 2.6% of septic patients had severe hypoglycemia (≤40 mg/dL) and 7.2% had mild hypoglycemia (41-70 mg/dL) on admission 3.
• Another study published in 2020 reported that 69 out of 1158 patients (6%) with severe sepsis had hypoglycemia (<70 mg/dL) on admission 4.
• The incidence of hypoglycemia in septic patients has been associated with increased mortality, with one study finding a 28-day mortality rate of 71.4% in patients with severe hypoglycemia compared to 8.7% in those with euglycemia 3.

Risk Factors for Sepsis-Induced Hypoglycemia

• Several risk factors have been identified for sepsis-induced hypoglycemia, including:
  • Acute kidney injury (AKI) 5
  • High Sequential Organ Failure Assessment (SOFA) scores 5, 4
  • Septic shock 4
  • Premorbid glycemia 6
• Intensive insulin therapy (IIT) has been associated with an increased risk of hypoglycemia in septic patients, but its clinical relevance remains to be defined 7.

Relationship Between Hypoglycemia and Mortality

• Several studies have demonstrated a significant relationship between hypoglycemia and increased mortality in septic patients 3, 4.
• One study found that hypoglycemia increased the mortality rate twofold, although this was not statistically significant 5.
• Another study reported that patients with both hypoglycemia and septic shock had a 2.5-times higher mortality rate than those without hypoglycemia and septic shock 4.