During our training period in surgical wards in the medical college, we encounter a lot of accident cases, non healing ulcers, necrotizing fascitis etc. Most of these people have one thing in common, increased blood sugar levels. One thing to note is that,these people were having completely normal or near normal values before they met with an accident or developed the disease.Naturally the question which springs up in our mind is:why does this happen?
Why do blood sugar values rise in injuries and infections?
In severe injury(including surgeries) and infections,plasma insulin concentrations initially fall as a result of sympathetic inhibition of pancreatic beta cells,but may rise to supra physiological levels after several days.A state of insulin resistance may persist for several weeks.There is increased breakdown of glycogen,lipid and muscle protein yielding amino acid precursors for glucose production.This increased hepatic glucose production cannot be inhibited by administering glucose or with physiological insulin concentrations.When combined with impaired insulin mediated glucose storage in skeletal muscle due to insulin resistance, this leads to a tendency to marked hyperglycemia and diabetes like state.