title: Baseline insulin/glucose ratio as a marker for the clinical course of hyperglycemic critically ill children treated with insulin.
abstract: OBJECTIVE
  The objective of this study was to investigate the relations of baseline insulin/glucose ratio to the clinical course of critically ill children. Such information will provide insight into the pathophysiologic mechanisms leading to hyperglycemia and will optimize preventive and therapeutic measures for hyperglycemia in critically ill children.
  
  
  METHODS
  Sixty-four consecutively admitted critically ill children with hyperglycemia, defined as a blood glucose level higher than 8 mmol/L (>145 mg/dL) and treated with insulin according to a glucose-control protocol, were included. Demographic data and clinical and laboratory parameters were collected. Insulin sensitivity was investigated by calculating the ratio of insulin to the blood glucose level just before the start of insulin administration. Results are expressed as median (range).
  
  
  RESULTS
  Sixty-four children (24 girls) 7.0 y of age (0.3-16.9 y) with various diagnoses were included. A hyperinsulinemic response, indicated by an increased insulin/glucose ratio (>18 pmol/mmol), was seen in 55% of children. The durations of insulin therapy, mechanical ventilation, and pediatric intensive care unit length of stay in children with a hyperinsulinemic response were longer than in children with a hypoinsulinemic response.
  
  
  CONCLUSIONS
  Hyper- and hypoinsulinemic responses play a role in the occurrence of hyperglycemia in critically ill children. Each is associated with a particular clinical course after the initiation of insulin therapy. It would be worthwhile to further investigate if the insulinemic response to hyperglycemia, determined by the insulin/glucose ratio in combination with the type of organ dysfunction, could be used in clinical practice to determine the need for insulin therapy.
authors.affiliation: Intensive Care, Erasmus MC-Sophia Children's Hospital, Erasmus MC, Rotterdam, The Netherlands. j.j.verhoeven@erasmusmc.nl
authors.forename: Jennifer J
authors.initials: JJ
authors.lastname: Verhoeven
authors.forename: Marianne
authors.initials: M
authors.lastname: Koenraads
authors.forename: Wim C J
authors.initials: WC
authors.lastname: Hop
authors.forename: Jeannette B
authors.initials: JB
authors.lastname: Brand
authors.forename: Mirjam M
authors.initials: MM
authors.lastname: van de Polder
authors.forename: Koen F M
authors.initials: KF
authors.lastname: Joosten
mesh_terms: D000293:Adolescent; D000465:Algorithms; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000032:analysis*; D002648:Child; D002675:Child, Preschool; D016903:Drug Monitoring; D005260:Female; D006776:Hospitals, Pediatric; D006785:Hospitals, University; D006801:Humans; D006943:Hyperglycemia / Q000150:complications / Q000188:drug therapy* / Q000209:etiology / Q000378:metabolism; D006946:Hyperinsulinism / Q000209:etiology / Q000517:prevention & control; D007223:Infant; D007328:Insulin / Q000009:adverse effects / Q000097:blood* / Q000627:therapeutic use*; D007333:Insulin Resistance; D015278:Intensive Care Units, Pediatric; D007902:Length of Stay; D008297:Male; D009426:Netherlands; D011446:Prospective Studies; D012131:Respiratory Insufficiency / Q000150:complications
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D007328:Insulin