Archived Comments for:
Clinical review: Strict or loose glycemic control in critically ill patients - implementing best available evidence from randomized controlled trials
Heikki Savolainen, Dept. of Occup. Safety & Hlth., Tampere, Finland
16 June 2010
Dear Editor,
The erudite review presents comprehensively the complexity of the management of hyperglycemia in a critical illness (1).
Treatment with insulin or with an other hypoglycemia-inducing agent causes the circulating glucose to enter in the responsive cells to be metabolised in them. Some of the downward metabolites, methylglyoxal and D-lactic acid (2), may hamper the cell functions.
Increased intracellular glucose concentrations may also initiate "Warburg effect"-like metabolic changes (3) if the oxygen delivery to the cells is simultaneously compromised. They include e.g. the activation of signal transduction pathways (3).
Thus, the correct treatment of hyperglycemia remains an unsettled issue until a firmer idea of the metabolic consequences of excessive intracellular glucose is available.
1 Schultz MJ, Harmsen RE, Spronk PE. Clinical review. Strict or loose glycemic control in critically ill patients - implementing the best available evidence from randomized controlled trials. Crit Care 2010; 14: 223.
2 Talasniemi JP, Pennanen S, Savolainen H, et al. Assay of D-lactate in diabetic plasma and urine. Clin Biochem 2008; 41: 1099.
3 Vander Heiden MG, Cantley LC, Thompson CB. Understanding the Warburg effect: The metabolic requirements of cell proliferation. Science 2009; 324: 1029.
Critical Care
Complexities of glycemic control
16 June 2010
Dear Editor,
The erudite review presents comprehensively the complexity of the management of hyperglycemia in a critical illness (1).
Treatment with insulin or with an other hypoglycemia-inducing agent causes the circulating glucose to enter in the responsive cells to be metabolised in them. Some of the downward metabolites, methylglyoxal and D-lactic acid (2), may hamper the cell functions.
Increased intracellular glucose concentrations may also initiate "Warburg effect"-like metabolic changes (3) if the oxygen delivery to the cells is simultaneously compromised. They include e.g. the activation of signal transduction pathways (3).
Thus, the correct treatment of hyperglycemia remains an unsettled issue until a firmer idea of the metabolic consequences of excessive intracellular glucose is available.
1 Schultz MJ, Harmsen RE, Spronk PE. Clinical review. Strict or loose glycemic control in critically ill patients - implementing the best available evidence from randomized controlled trials. Crit Care 2010; 14: 223.
2 Talasniemi JP, Pennanen S, Savolainen H, et al. Assay of D-lactate in diabetic plasma and urine. Clin Biochem 2008; 41: 1099.
3 Vander Heiden MG, Cantley LC, Thompson CB. Understanding the Warburg effect: The metabolic requirements of cell proliferation. Science 2009; 324: 1029.
Competing interests
None