Dr Kramer is correct in pointing out that hyperglycemia in neonates with sepsis may have multiple etiologic factors. We were unable to measure the possible contributing effects of human growth hormone, hydrocortisone, glucagon, or catecholamines. Cryer et al1 measured these hormones in baboons with Escherichia coli sepsis. They concluded that an inadequate insulin response was sufficient to account for hyperglycemia in sepsis.1 Our patient had serum levels of insulin of 11 μU/mL and 13 μU/mL when her serum concentrations of glucose were 314 mg/dL and 285 mg/dL, respectively. For these glucose levels one would anticipate a greater insulin response.2 Since our patient was apparently incapable of greater insulin production, I must assume that her response was inadequate. However, I do not have the data to indicate if this inadequate response were the result of sepsis or of the immaturity of a 1.3-kg, 1-month-old, preterm infant.
James T. Hyperglycemia and Sepsis in a Newborn-Reply. Am J Dis Child. 1980;134(4):427. doi:10.1001/archpedi.1980.04490010077026