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Cardio Diabetes Medicine 2017 499

Hyperglycemia has a number of Immunomodulatory • Direct destruction of beta cells (e.g. parotitic pan-
effects: creatitis).

Can compromise innate immunity by: Impairing poly- • Molecular mimicry: microbial antigens share ho-
morphonuclear neutrophil function,Intracellular bac- mologies with host antigens (e.g. Cytomegalovirus
tericidal activity&Opsonic activity.High glucose levels and Epstein-Barr virus).
can promote excessive inflammation as evidenced • Increased processing and presentation of autoan-
by increasing proinflammatory cytokines (such as tu- tigens during infection or epitope spreading which
mor necrosis factor-α and interleukins 1β, 6, 8, and make the beta cells a target of the immune system
18), inducing nuclear factor-κB, and up- regulating and enhances autoimmunity.
leukocyte adhesion molecules
• Increasing inflammation and the secretions of in-
Number of important biologic effects that may ex- flammatory cells such as cytokines.
plain the apparent association between glucose
excursions and poor outcomes in the ICU.Hypergly- • Increased insulin requirement during infection.
cemia additionally induces formation of advanced
glycation end products, which is now recognized to Hyperglycemia Adversely Affects Outcomes
promote inflammation and endothelial dysfunction. Hyperglycemia impacts
High BG levels lead to oxidative stress and promote a
procoagulant state. Hyperglycemia has been shown • Mortality ↑
to correlate with development of congestive heart fail- • Morbidity ↑
ure, cardiogenic shock, and hospital mortality among
patients admitted for acute myocardial infarction • Rate of infections ↑
• Length of stay in ICU ↑
Infections can elicit diabetes

Infections cause metabolic derangements and con- VENTILATION DURATION IS INCREASED
versely metabolic derangements can facilitate infec- Hyperglycemia linked to higher mortality regardless
tion. The infection can induce diabetes by different of status of diabetes
mechanisms including:

Pic1: Stress Hyperglycemia exacerdates illness

Cardio Diabetes Medicine