Critical Illness Hyperglycemia – New Cause Identified

Hyperglycemia in children differs as to its endocrinologic origin depending on the progression of the condition. This is what the researchers said in the journal called Critical Care. They said that the dysfunction of the primary beta cells and the peripheral insulin resistance can lead to CIH in children.What is CIH? It is acronym for Critical Illness Hyperglycemia. Mark Rigby and Catherine Preissig of Atlanta’s Emory University School of Medicine studied 41 children who were receiving intensive care treatment. These researchers described how both peripheral insulin resistance and primary beta-cell dysfunction can cause CIH in children. Here are the other things they found:It was interesting to note that the children in the intensive care unit are not likely to develop critical illness hyperglycemia if they do not have either the cardiovascular or respiratory failure. Those with respiratory failure alone may or may not develop CIH. Those with both RF and cardiovascular failure develop CIH.The conclusion they came out of these data was that for the children with respiratory failure only, the cause of CIH is the high insulin resistance whereas for the children who have both the respiratory and cardiovascular failure, the cause is the dysfunction of the beta cells.As mentioned above, for the CIH in children who had both cardiovascular and respiratory problem the cause was the dysfunction of the beta cells. Those with respiratory failure only, the CIH was caused by elevated insulin resistance. Understanding this concept may impact the course of the condition and the treatment approach. How? Let me explain.In terms of cause and reasons, there are differences between patients with both respiratory failure and cardiovascular failure and patients who have respiratory failure alone. These differences will show that tailoring the treatment strategies to each group will lead to better result.It is clear that developing individualized strategy will help these patients who are suffering critical illness hyperglycemia. Developing glycemic goals in children with life-threatening illness, for instance, have to be tailored to the needs of the individuals concerned.What is known about beta cells dysfunction? Research has shown there are five stages to this. The first stage is when the secretion of insulin increases to compensate with the resistance to insulin and the decrease in the mass of the B-cell. The glucose levels begin to rise in step 2 while step 3 is characterized by a period of instability with the glucose level rising rapidly.Stage 4 is when decompensation is more stable with the B-cell differentiation more severe. The final stage 5 is characterized by more severe decompensation with the B-cell greatly reduced and progression to ketosis is on.There is a need for more studies to determine if treatment with insulin for both groups is effective since in addition to the differences mentioned above, those with both respiratory and cardiovascular failure had more severe CIH than those with either the respiratory or cardiovascular alone was present.Knowing that this condition is the result of the dysfunction of the beta cells in children who are critically ill with cardiovascular and respiratory failure will lead to appropriate therapeutic measures. The treatment option may be different if the cause is respiratory failure. Then the approach will not be the same for this hyperglycemia.

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