Skip to main content
  • Poster presentation
  • Open access
  • Published:

Endogenous insulin secretion in critically ill patients

Introduction

Glucose-insulin system models can be used for improved glycemic control of critically ill patients. A key component of glucose-insulin models is pancreatic insulin secretion. There are limited data in the literature quantifying insulin secretion in critically ill patients at physiologic levels. This study presents a model of pancreatic insulin secretion in critically ill patients based on data from a critically ill population.

Methods

Samples were collected from 19 patients enrolled in a prospective clinical trial studying sepsis at the Christchurch Hospital ICU. Fifteen of the patients had confirmed sepsis and three were diagnosed type 2 diabetics. All patients were on the SPRINT glycaemic control protocol [1]. Each patient had arterial blood samples assayed for insulin and C-peptide. Two sets of four samples were taken from each patient, with each set collected over 60 minutes. Blood glucose (BG) data were collected with a bedside glucometer. C-peptide data were deconvolved using the model and population parameter values of van Cauter and colleagues [2] to determine pancreatic insulin secretion rates (ISRs). Data from Kjems and colleagues investigating the potentiating effects of glucagon-like peptide-1 on insulin secretion [3] suggested a maximum secretion rate of 16 U/hour. A minimum rate of 1 U/hour was also adopted.

Results

The best model for insulin secretion was based on blood glucose concentration alone. There was clear separation of secretion levels between normal glucose tolerant (NGT) and impaired glucose tolerant (IGT) patients. Hence, ISR was modeled as a constrained linear function of BG (in mmol/l) for NGT and IGT patients separately with R2 = 0.61 and 0.69 respectively. NGT: ISR = 893 × BG - 2,996 (mU/hour). IGT: ISR = 296 × BG - 1,644 (mU/hour). The glucose coefficients of 893 and 296 mU.l/mmol.hour were comparable to data published in a number of other studies for healthy and diabetic subjects.

Conclusion

This work presents a simple model for pancreatic insulin secretion in critically ill patients based on clinical data. The model is a function of blood glucose level and glucose tolerance status and compares well with published data for healthy and diabetic subjects. This model can be incorporated into glucose-insulin system models and could potentially improve model-based glycaemic control.

References

  1. Chase JG, et al.: Crit Care. 2008, 12: R49. 10.1186/cc6868

    Article  PubMed Central  PubMed  Google Scholar 

  2. Van Cauter E, et al.: Diabetes. 1992, 41: 368-377. 10.2337/diabetes.41.3.368

    Article  CAS  PubMed  Google Scholar 

  3. Kjems L, et al.: Diabetes. 2003, 52: 380-386.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Cite this article

Pretty, C., Le Compte, A., Lin, J. et al. Endogenous insulin secretion in critically ill patients. Crit Care 16 (Suppl 1), P168 (2012). https://doi.org/10.1186/cc10775

Download citation

  • Published:

  • DOI: https://doi.org/10.1186/cc10775

Keywords