Extreme Insulin Resistance in Critically Ill Patient With Sepsis

Patients who are critically ill can develop acute insulin resistance manifesting as hyperglycemia and hyperinsulinemia. Rarely, patients can develop extreme insulin resistance, defined as having an insulin requirement of >3 units/kg/day (1). We report here a case of a septic patient who developed acute extreme insulin resistance in the critical care setting that was difficult to treat, and after 4 days, reversed rapidly, necessitating rapid down-titration of the intravenous insulin infusion and close blood glucose monitoring to avoid hypoglycemia. This case illustrates a general lack of understanding of 1) why severe insulin resistance occurs, 2) how to treat this clinical dilemma safely and effectively, and 3) what the treatment goals should be to achieve the best medical outcomes.