Insulin resistance in critical illness

Archana Dhar, Leticia Castillo

Research output: Contribution to journalReview article

23 Citations (Scopus)

Abstract

Purpose of review: The purpose of this review is to describe current concepts on inflammation, immunity and insulin resistance. Metabolic and immune systems are closely involved in inflammation and significantly contribute to the pathology seen in the pediatric intensive care unit. The ability of insulin to decrease hepatic glucose production, suppress adipose tissue lipolytic rate, stimulate skeletal muscle glucose uptake, suppress protein breakdown and increase protein synthesis is critical to maintain metabolic function. Hence, a better understanding of these regulatory mechanisms and the alterations leading to dysfunction will set the basis for a better metabolic and immune support of critically ill patients. Recent findings: Inflammation can be elicited by infection (sepsis) through pathogen associated molecular patterns (PAMPs) or through danger associated molecular patterns (DAMPs) as a response to an insult (systemic inflammatory response syndrome; SIRS) in the absence of infection. Mitochondrial DAMPs and PAMPs share the same pattern recognition receptors. These receptors act also as nutrient sensors, and in the presence of fatty acids will induce an inflammatory cascade that affects insulin signaling with development of insulin resistance. Lipotoxicity is emerging as a significant contributor to the development of insulin resistance. Summary: Insulin resistance is an adaptive mechanism that prioritizes utilization of energy for immune response in the presence of infection or injury. A better understanding of the complex interactions between metabolism, inflammation and immunity in critically ill children will lead to appropriate metabolic and immune support of these patients.

Original languageEnglish (US)
Pages (from-to)269-274
Number of pages6
JournalCurrent Opinion in Pediatrics
Volume23
Issue number3
DOIs
StatePublished - Jun 1 2011
Externally publishedYes

Fingerprint

Critical Illness
Insulin Resistance
Inflammation
Immunity
Infection
Insulin
Pattern Recognition Receptors
Glucose
Systemic Inflammatory Response Syndrome
Pediatric Intensive Care Units
Adipose Tissue
Immune System
Sepsis
Skeletal Muscle
Proteins
Fatty Acids
Pathology
Food
Liver
Wounds and Injuries

Keywords

  • hyperglycemia
  • inflammation
  • insulin resistance
  • pattern recognition receptors

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Insulin resistance in critical illness. / Dhar, Archana; Castillo, Leticia.

In: Current Opinion in Pediatrics, Vol. 23, No. 3, 01.06.2011, p. 269-274.

Research output: Contribution to journalReview article

Dhar, Archana ; Castillo, Leticia. / Insulin resistance in critical illness. In: Current Opinion in Pediatrics. 2011 ; Vol. 23, No. 3. pp. 269-274.
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