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March 12, 2003

Hyperglycemia in Acute Illness—Reply

Author Affiliations

Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.

JAMA. 2003;289(10):1244. doi:10.1001/jama.289.10.1244-a

To the Editor: In their Contempo Updates article about hyperglycemia in patients with acute illness, Dr Montori and colleagues1 suggest that most complications are attributable to high glucose levels rather than to insulin deficiency. Insulin, however, has many metabolic functions other than regulation of glucose. Both major surgery and acute illness are associated with insulin resistance, resulting in a catabolic state of profound muscle protein loss, despite adequate enteral or parenteral nutrition.2 This is analogous to the loss of muscle protein in patients with type 1 diabetes who have inadequate insulin replacement.

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