What is the recommended approach to glucose management in sepsis and stress?

• A. Stress hormones induce insulin resistance; glucose levels should be adequately controlled to avoid polyuria and electrolyte disturbances
• B. Do not monitor glucose in sepsis
• C. Target glucose < 90 mg/dL
• D. Always maintain glucose > 180 mg/dL

Answer: (A)

In sepsis and other critical illness, stress hormones such as cortisol, epinephrine, glucagon, and growth hormone drive insulin resistance and increased hepatic glucose production. This makes hyperglycemia common, so the goal is to actively manage glucose to prevent the osmotic diuresis and electrolyte disturbances that hyperglycemia can cause, while avoiding hypoglycemia from overly aggressive correction. Therefore, monitoring glucose and applying insulin therapy as needed to keep glucose in a safe, moderate range is the appropriate approach. Keeping glucose extremely low or extremely high is not advisable, and not monitoring glucose ignores a key risk in these patients.