Anti-inflammatory effects of insulin and pro-inflammatory effects of glucose: relevance to the management of acute myocardial infarction and other acute coronary syndromes.
Hyperglycemia worsens morbidity and mortality for patients in intensive care or with acute myocardial infarction, stroke, or coronary artery bypass grafts. The control of hyperglycemia with insulin improves clinical outcomes for patients with these conditions. This article reviews the anti-inflammatory effects of insulin and pro-inflammatory effects of glucose and free fatty acids, and provides a mechanistic justification for maintaining euglycemia with insulin infusions. Hyperglycemia induced by infusions of a fixed dose of insulin with high rates of glucose may neutralize the benefit of insulin, and such regimens should be replaced by infusion of insulin to restore and maintain euglycemia.
Dandona
Paresh
P
Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, School of Medicine and Biomedical Sciences, State University of New York at Buffalo, New York, USA.
Chaudhuri
Ajay
A
Ghanim
Husam
H
Mohanty
Priya
P
D054058:Acute Coronary Syndrome / Q000150:complications / Q000188:drug therapy* / Q000378:metabolism / Q000401:mortality; D000818:Animals; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D050197:Atherosclerosis / Q000188:drug therapy / Q000378:metabolism; D001786:Blood Glucose / Q000187:drug effects / Q000378:metabolism*; D001026:Coronary Artery Bypass / Q000009:adverse effects; D004195:Disease Models, Animal; D004334:Drug Administration Schedule; D005230:Fatty Acids, Nonesterified / Q000378:metabolism; D005947:Glucose / Q000008:administration & dosage / Q000009:adverse effects; D006801:Humans; D006943:Hyperglycemia / Q000150:complications / Q000188:drug therapy* / Q000378:metabolism / Q000401:mortality; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D007249:Inflammation / Q000188:drug therapy* / Q000209:etiology / Q000378:metabolism / Q000401:mortality; D007263:Infusions, Parenteral; D007328:Insulin / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D009203:Myocardial Infarction / Q000150:complications / Q000188:drug therapy* / Q000378:metabolism / Q000401:mortality; D009765:Obesity / Q000150:complications / Q000378:metabolism; D011188:Potassium / Q000008:administration & dosage / Q000009:adverse effects; D017382:Reactive Oxygen Species / Q000378:metabolism; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome
D000893:Anti-Inflammatory Agents; D001786:Blood Glucose; D005230:Fatty Acids, Nonesterified; D007004:Hypoglycemic Agents; D007328:Insulin; D017382:Reactive Oxygen Species; C030396:glucose-insulin-potassium cardioplegic solution; D005947:Glucose; D011188:Potassium