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To the Editor: In their Contempo Updates article about hyperglycemia in patients with acute illness, Dr Montori and colleagues¹ suggest that most complications are attributable to high glucose levels rather than to insulin deficiency. Insulin, however, has many metabolic functions other than regulation of glucose. Both major surgery and acute illness are associated with insulin resistance, resulting in a catabolic state of profound muscle protein loss, despite adequate enteral or parenteral nutrition.² This is analogous to the loss of muscle protein in patients with type 1 diabetes who have inadequate insulin replacement.

Insulin treatment can possibly decrease the effects of hypercatabolism associated with acute illness,³ but this has yet to be adequately addressed in clinical studies. In one study of patients in intensive-care units, mortality and blood glucose levels were higher in a cohort of patients treated with growth hormone,⁴ while another study found lower mortality in a cohort in . . . [Full Text of this Article]

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