- Definition: Transient BG > 140 mg/dL in acute illness w/o prior DM.
- Pathophysiology:
- Counter-Regulatory Hormones (Cortisol, Catecholamines, Glucagon, GH) + Cytokines (TNF-α, IL-6).
- Result: ↑ Gluconeogenesis, ↑ Glycogenolysis, ↑ Insulin Resistance.
- Etiology: Sepsis, Severe Trauma/Burns, MI, Stroke.
- Key Associations:
- Poor Prognosis: ↑ Mortality in ICU.
- Immune suppression: Impairs neutrophil function → poor wound healing.
- Dx: Check HbA1c to distinguish from undiagnosed DM.
- Tx:
- Target: 140–180 mg/dL (NICE-SUGAR trial).
- Avoid tight control (80-110 mg/dL) → risk of hypoglycemia.
- Drug of choice: IV Insulin (rapid titration).