Insulin And Its Components Profile During Stress Hyperglycemia In Paediatric Intensive Care Unit

Insulin and its components profile during stress hyperglycemia in paediatric intensive care unit Background/ObjectivesThe patients in paediatric intensive care unit usually have stress hyperglycemia. Researches indicate an endocrine disorder that can make blood glucose step-up called stress hyperglycemia in patients of sepsis,injury,stress,et al.When twice or more of blood-fasting sugar greater than or equal to 6.9mmol/L or random blood sugar greater than or equal to 11.1mmol/L can be called stress hyperglycemia.The stress hyperglycemia result to hyperosmolality diuresis,anoxia of brain,increasing the chance of infection,et al,can effect the prognosis of patients in fine.The reserch of stress hyperglycemia find that the causes of stress hyperglycemia are insulin resistance and the paracrisis of insulin.There are proinsulin,true insulin and proinsulin-like-molecules(PLMs) in blood.Researches indicate the proportionality of proinsulin phanero- ascensus in the patients of type 2 diabetes mellitus,and the abnormality of these constituent can reflex the disturbance of beta Cell of islet's secretion.But the change of insulin of patients in paediatric intensive care unit is not identify yet.We undertook a study about the relationships of the level of blood glucose with the degree of critical illness and the level of insulin,and the change of insulin.MethodsWe undertook a retrospective discriptive study of critical ill admissions to the paediatric intensive care unit to find out their glycometabolism disorder.The objectives were scored in 24 hours after admission,the children who admissioned to the paediatric intensive care unit were divided into critical ill children and the children who admissioned to the general wards were divided into control group.The critical ill children were divided into stess hyperglycemia group and non-stess hyperglycemia group and compered to control group.The immunoactive insulin;immunoreactive insulinN true insulin,C-Peptide and blood glucose were measured.Outcomes were recorded.All the statistics were anlysized by SPSS13.0. Result1.We studied 58 admissions to the patients' rooms,including 36 males and 22 females from two month to 12 years old with 2.8Kg to 31Kg body weight.There were 42 critical ill children and 16 control group children.12 of them died(including 2 patients' renunciation of medical treatment).Severe pneumonia counted for a high proportion as primary disease.There were 42 critical ill children including 20 children of stess hyperglycemia group and 9 of them died.The mortality was 45%, significantly higher than that in non-stess hyperglycemia group.The score of stess hyperglycemia group was 84.1±9.07,significantly higher than that in non-stess hyperglycemia group.2.0h IRI of stess hyperglycemia group was 86.16±146.19uIU/ml,0h TI of stess hyperglycemia group was 121.0±94.89pmol/L,0h C-Peptide of stess hyperglycemia group was 3.23±1.55ng/ml.0h IRI of non-stess hyperglycemia group was 22.74±13.86uIU/ml,0h TI of non-stess hyperglycemia group was 121.0±94.89pmol/L,0h C-Peptide of non-stess hyperglycemia group was 3.23±1.55ng/ml.IRI of control group was 9.68±4.7uIU/ml,TI of control group was 63.65±40.9pmol/L,C-Peptide of control group was 1.9±1.14ng/ml.0h TI,IRI and C-Peptide in stress hyperglycemia were all significantly higher than that in non-stess hyperglycemia group and cotrol group.0h TI,IRI and C-Peptide in non-stess hyperglycemia were all significantly higher than that in cotrol group.3.The 48h TI of stess hyperglycemia group was 218.48±146.02pmol/L,significantly higher than 106.96±112.27pmol/L in non-stess hyperglycemia group.So 0h and 48h TI were significantly higher than non-stess hyperglycemia group.48h TI of stess hyperglycemia group was significantly lower than 0h TI of stess hyperglycemia group.Significant difference wasn't found between 0h TI and 48h TI of non-stess hyperglycemia group.4.The 48h IRI of stess hyperglycemia group was 61.58±73.53uIU/ml,significantly higher than 22.99±14.36uIU/ml in non-stess hyperglycemia group.So 0h and 48h IRI were significantly higher than non-stess hyperglycemia group.Significant difference wasn't found between 0h IRI and 48h IRI of the two group.5.The insulin resistance index of stess hyperglycemia group was 46.76±94.05, significantly higher than 5.32±3.26 in non-stess hyperglycemia group and 1.91±1.03 in control group.The insulin resistance index of non-stess hyperglycemia group was significantly higher than control group.Conclusion1.47.62%of the critical ill children have stess hyperglycemia.2.0h IRI,TI,C-Peptide and insulin resistance index of stess hyperglycemia group were significantly higher than non-stess hyperglycemia group and control group;0h IRI,TI,C-Peptide and insulin resistance index of non-stess hyperglycemia group were significantly higher than control group.3.The score of stess hyperglycemia group was significantly lower than non-stess hyperglycemia group.4.TI/IRI of stress hyperglycemia group was significantly lower than non-stess hyperglycemia group.