Hyperglycemia in acutely ill and septic patients occurs due to which three mechanisms?

• A. Insulin resistance, increased gluconeogenesis and glycogenolysis, and suppressed insulin secretion
• B. Insulin resistance
• C. Increased gluconeogenesis and glycogenolysis
• D. Suppressed insulin secretion

Answer: (A)

The main concept here is that stress-related hyperglycemia in acutely ill and septic patients is multifactorial, driven by a combination of insulin resistance, increased production of glucose by the liver, and impaired insulin secretion. In critical illness, inflammatory cytokines and stress hormones blunt insulin signaling, so tissues don’t take up glucose efficiently (insulin resistance). At the same time, the liver is driven to produce more glucose through both gluconeogenesis and glycogenolysis, fueled by higher levels of cortisol, catecholamines, and glucagon. Adding to this, the pancreas may release less insulin than needed or the beta cells may be temporarily dysfunctional, worsening the relative insulin deficiency. The integration of these three mechanisms—reduced insulin action, more hepatic glucose output, and insufficient insulin—explains why hyperglycemia is so common in these patients. The other options capture only one aspect at a time, but the combination provides the complete explanation.