title: Patterns of exogenous insulin requirement reflect insulin sensitivity changes in trauma.
abstract: BACKGROUND
  We investigated patterns of blood glucose and exogenous insulin requirement in the intensive care unit, and questioned whether they reflect fluctuations in insulin activity.
  
  
  METHODS
  Records for burn intensive care unit patients with 7 days of glucose control with insulin were reviewed. Hourly blood glucose and insulin dose were matched for time collected and analyzed with linear and cosine regression. Frequency analysis identified recurring patterns.
  
  
  RESULTS
  Diurnal patterns of blood glucose and insulin requirement were noted (insulin troughs = noon; insulin peaks = midnight; glucose troughs = 5 am; glucose peaks = 5 pm). Average insulin requirement increased at a constant linear rate (slope = .013, r2 = .57, P < or = .001).
  
  
  CONCLUSIONS
  Diurnal patterns in blood glucose and insulin requirement mirror those of healthy subjects and may reflect persistence of normal variability in insulin activity. The 5-hour offset in peaks and troughs is suggestive of complex interplay between insulin availability and receptor sensitivity. The insulin requirement to blood glucose ratio increased, evidence that insulin resistance progresses over time.
authors.affiliation: United States Army Institute of Surgical Research, Brooke Army Medical Center, 3400 Rawley E. Chambers Ave, Fort Sam Houston, TX 78234-6315, USA. heather.pidcoke@amedd.army.mil
authors.forename: Heather F
authors.initials: HF
authors.lastname: Pidcoke
authors.forename: Jose
authors.initials: J
authors.lastname: Salinas
authors.forename: Sandra M
authors.initials: SM
authors.lastname: Wanek
authors.forename: Marybeth
authors.initials: M
authors.lastname: Concannon
authors.forename: Florence
authors.initials: F
authors.lastname: Loo
authors.forename: Kelly L
authors.initials: KL
authors.lastname: Wirfel
authors.forename: John B
authors.initials: JB
authors.lastname: Holcomb
authors.forename: Steven E
authors.initials: SE
authors.lastname: Wolf
authors.forename: Charles E
authors.initials: CE
authors.lastname: Wade
mesh_terms: D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000032:analysis*; D001830:Body Surface Area; D002056:Burns / Q000503:physiopathology*; D002940:Circadian Rhythm / Q000502:physiology; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000503:physiopathology*; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D015601:Injury Severity Score; D007328:Insulin / Q000008:administration & dosage*; D007333:Insulin Resistance / Q000502:physiology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin