Sepsis potentially leading to hypoglycemia?
Sepsis, a life-threatening reaction to an infection, can lead to several serious complications, including tissue damage, organ failure, and even death. One lesser-known complication is hypoglycemia, a condition characterized by low blood sugar levels.
Hypoglycemia occurs when the sugar in the bloodstream dips lower than 70 milligrams per deciliter of blood (mg/dL). In the context of sepsis, hypoglycemia is associated with severe sepsis or septic shock, indicating advanced disease or organ failure.
Sepsis causes hypoglycemia primarily by impairing hepatic glucose production, increasing glucose consumption by activated immune and other cells, and disrupting hormonal regulation necessary for maintaining normal blood glucose levels.
The key mechanisms include:
- Hepatic dysfunction: In sepsis, liver function may be compromised due to inflammation and hypoperfusion, reducing the liver's ability to produce glucose via gluconeogenesis and glycogenolysis.
- Increased peripheral glucose utilization: Activated immune cells and other tissues during sepsis have increased metabolic demands and consume more glucose, which can lower serum glucose levels.
- Dysregulated counter-regulatory hormones: In severe sepsis or septic shock, the typical stress response that elevates blood glucose (via cortisol, glucagon, catecholamines) may become impaired or overwhelmed, resulting in inadequate glucose production or inappropriate insulin secretion.
- Cytokine effects: Pro-inflammatory cytokines can interfere with gluconeogenesis and promote increased glucose uptake by macrophages and other cells.
- Adrenal insufficiency: Relative adrenal insufficiency in sepsis can blunt cortisol and catecholamine responses, further impairing glucose homeostasis.
- Impaired insulin clearance and possible hyperinsulinemia: Some septic patients may have altered insulin metabolism contributing to hypoglycemia.
While hyperglycemia is more common in sepsis due to stress-induced insulin resistance and increased gluconeogenesis, hypoglycemia is a marker of poor prognosis. People living with diabetes or pre-existing hyperglycemia may have a better outcome from sepsis than those who develop hyperglycemia due to sepsis.
It's important to note that over-treatment of high blood sugar levels in sepsis patients can inadvertently trigger hypoglycemia.
Treatment options for sepsis may include antibiotics to treat the underlying infection, intravenous fluids, medications to help with blood pressure and prevent blood clots, removing the source of infection, providing nutrients, surgery to remove an organ or dead tissue, breathing support, dialysis if the kidneys become damaged, and other therapies.
About 50% of people who survive sepsis will develop post-sepsis syndrome, which can cause several symptoms including depression or mood swings, lack of energy, difficulty falling asleep or staying asleep, low appetite, shortness of breath or difficulty breathing, loss of self-esteem, swelling in the arms or legs, hallucinations, disabling muscle or joint pain, panic attacks, flashbacks, or nightmares.
A 2021 systematic review and meta-analysis suggest that blood glucose levels may help indicate disease severity in those with sepsis. Early treatment can help restore blood glucose levels and prevent complications.
[1] Reference 1 [2] Reference 2 [3] Reference 3 [4] Reference 4 [5] Reference 5
- Sepsis, a severe reaction to infections, can also lead to bloodpoisoning, tissue damage, organ failure, and even death.
- Hypoglycemia, characterized by low blood sugar levels (less than 70 mg/dL), is a less-known complication of sepsis.
- In the context of sepsis, hypoglycemia is associated with severe sepsis or septic shock, indicating advanced disease or organ failure.
- Sepsis causes hypoglycemia primarily by impairing hepatic glucose production, increasing glucose consumption, and disrupting hormonal regulation.
- Hepatic dysfunction in sepsis reduces the liver's ability to produce glucose via gluconeogenesis and glycogenolysis.
- Activated immune cells and other tissues during sepsis have increased metabolic demands, consuming more glucose and lowering serum glucose levels.
- Dysregulated counter-regulatory hormones in severe sepsis can impair glucose production or inappropriately stimulate insulin secretion.
- Pro-inflammatory cytokines can interfere with gluconeogenesis and promote increased glucose uptake by macrophages and other cells.
- Relative adrenal insufficiency in sepsis can blunt cortisol and catecholamine responses, further impairing glucose homeostasis.
- Altered insulin metabolism may contribute to hypoglycemia in some septic patients.
- Hyperglycemia is more common in sepsis due to stress-induced insulin resistance and increased gluconeogenesis, but hypoglycemia is a marker of poor prognosis.
- People with pre-existing diabetes or hyperglycemia may have a better outcome from sepsis due to having a more robust stress response.
- Over-treatment of high blood sugar levels in sepsis patients can unintentionally trigger hypoglycemia.
- Treatment options for sepsis may include antibiotics, IV fluids, blood pressure medications, blood clot prevention drugs, removal of infection sources, nutritional support, surgery, breathing support, dialysis, and various therapies.
- About 50% of sepsis survivors may develop post-sepsis syndrome with symptoms like depression, sleep disorders, low appetite, shortness of breath, low self-esteem, and muscle/joint pain.
- A 2021 systematic review suggests that blood glucose levels may help determine disease severity in sepsis patients, and early treatment can help prevent complications.
- Facing sepsis, diabetes, hyperglycemia, and other chronic diseases, the field of medicine, worker-wellness programs, and health-and-wellness initiatives emphasize the importance of science, fitness-and-exercise, nutrition, mental-health, and environmental-science for disease prevention and management.
