Septic shock: blood glucose regulation |
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| Authors: | Orban J-C Deroche D Ichai C |
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| Affiliation: | 1. Faculté de médecine, université d’Auvergne, 28, place Henri-Dunant, BP 38, 63001 Clermont-Ferrand cedex 1, France;2. Service d’urologie, hôpital G.-Montpied, 58, rue Montalembert, 63003 Clermont-Ferrand cedex 1, France;3. Service de thérapie cellulaire et d’hématologie clinique, place Lucie-et-Raymond-Aubrac, 63003 Clermont-Ferrand cedex 1, France;4. Aix-Marseille université, 13284 Marseille, France;5. Service d’urologie, hôpital Nord, Assistance publique–hôpitaux de Marseille, 13385 Marseille cedex 5, France;6. Service d’oncologie, centre Jean-Perrin, 58, rue Montalembert, BP 392, 63011 Clermont-Ferrand, France;7. Université François-Rabelais de Tours, PRES centre Val-de-Loire université, 60, rue du Plat-d’Etain, 37000 Tours, France;8. Service d’urologie, CHRU Bretonneau, 37044 Tours cedex 9, France;9. Service d’urologie et transplantation rénale, hôpital de la Conception, Assistance publique–hôpitaux de Marseille, 13385 Marseille cedex 5, France;1. Laboratório de Pesquisa em Infectologia, Salvador, BA, Brazil;2. Universidade Federal da Bahia, Escola de Medicina Salvador, Complexo Hospitalar Prof. Edgard Santos, Salvador, BA, Brazil;1. Service de radio-isotopes et médecine nucléaire, université Mohammed V-Souissi, hôpital militaire d’instruction Mohammed V, Rabat, Maroc;2. Service de chirurgie thoracique, hôpital militaire d’instruction Mohammed V, Rabat, Maroc;3. Service de radiothérapie, hôpital militaire d’instruction Mohammed V, Rabat, Maroc;1. Department of obstetrics and gynecology, hôpital Foch, 40, rue Worth, 92151 Suresnes, France;2. Inserm U1193, National reference laboratory for maternofetal rubella infections, service de virologie, hôpital Paul-Brousse, WHO Rubella NRL, université Paris-Sud, groupe hospitalier universitaire Paris-Sud, AP–HP, 94804 Villejuif, France;3. EA2493, UFR des sciences de la santé Simone-Veil, université Versailles Saint-Quentin-en-Yvelines, 78180 Montigny-le-Bretonneux, France;4. Service des maladies infectieuses et tropicales, hôpital Bichat, HPNVS, AP–HP, 46, rue Henri-Huchard, 75018 Paris, France;5. Inserm, infections, antimicrobiens, modélisation, évolution (IAME), UMR 1137, université Paris Diderot, Sorbonne Paris Cité, Paris, France;6. Department of gynecology, obstetrics and reproduction, Bichat-Claude-Bernard hospital, Assistance publique–Hôpitaux de Paris, 46, rue Henri-Huchard, 75018 Paris, France;7. DHU risque et grossesse, Paris 7-Denis Diderot university, Paris, France;8. Service des maladies infectieuses et tropicales, AP–HP, Hôpital Bichat, HPNVS, Paris 7-Denis Diderot University, Paris, France;9. Inserm, infections, antimicrobiens, modélisation, évolution (IAME), UMR 1137, Paris 7-Denis Diderot University, 75018 Paris, France;10. Service de gynécologie-obstétrique, hôpital de la Croix-Rousse, hospices civils de Lyon, 103, Grande-Rue-de-la-Croix-Rousse, 69317 Lyon cedex 04, France;11. Université Claude-Bernard Lyon 1, UER Lyon-Est, 8, avenue Rockefeller, 69008 Lyon, France;12. Inserm U846, Stem cell and brain research institute, 18, avenue Doyen-Lepine, 69500 Bron, France;13. UMR-S 846, université de Lyon, Lyon 1, 69003 Lyon, France;14. Centre hospitalier de l’Ouest guyanais, Saint-Laurent-du-Maroni, Guyane française;15. Department of obstetrics, gynecology and reproductive medicine, centre maladies rares, hernie de coupole diaphragmatique, hôpital Antoine-Béclère, université Paris Sud, AP–HP, 92140 Clamart, France;p. Service de pédiatrie générale et maladies infectieuses, hôpital Robert-Debré, Assistance publique–Hôpitaux de Paris, 48, boulevard Serrurier, 75019 Paris, France;q. Inserm 1123, université Paris 7 Denis Diderot, Sorbonne Paris Cité, Paris, France;r. Risk in pregnancy university department, Paris, France;s. Service de gynécologie et obstétrique, hôpital Louis-Mourier, Assistance publique–Hôpitaux de Paris, 178, rue des Renouillets, 92700 Colombes, France;t. Université Paris-Diderot, Paris, France;u. Inserm CESP, 1019 Kremlin-Bicêtre, France;v. Coordination de la surveillance des maladies vectorielles, département des maladies infectieuses, institut de veille sanitaire, 94415 Saint-Maurice, France |
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| Abstract: | Blood glucose regulation is controlled by several hormones, neurological mechanisms and the hepatic autoregulation. Glucose uptake necessitates glucose transporters which are called GLUT. In physiological situation, 80% of glucose uptake of the whole body is produced by the non-insulin dependant tissues, via the GLUT 1 to 3 transporters. Glucose uptake by insulin dependant tissues is mediated by insuline, which activates GLUT-4 transporters. Because of the production of pro-inflammatory mediators (TNF-alpha), sepsis induces hyperglycemia, which results essentially from an hepatic insulinoresistance. This phenomenon leads to an acute load and uptake of glucose by the non-insulin dependant tissues. Hyperglycemia modifies inflammatory and immune reactions and enhances the production of reactive oxygen species. Thus, sepsis has an impact on blood glucose control and conversely. Blood glucose control has been found to decrease mortality and morbidity in critically ill patients. The exact mechanism, by which these beneficial effects are produced, remains controversial, due to euglycemia or to insulin infusion. Probably both mechanisms are implicated. In all cases the beneficial effects seem to be multifactorial: a decrease in oxydative stress, a protective effect in front of the burst suppression, multiple anti-inflammatory effects. The optimum level of blood glucose is still discussed and must be evaluated in further studies. In all cases, blood glucose level must be under or equal to 1,4 g/l. Even no clinical study evaluates precisely the impact of hyperglycemia during sepsis, a lot of arguments supports that blood glucose level must be a therapeutic goal in these situations. |
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