Anti-inflammatory effects of insulin and the pro-inflammatory effects of glucose.

Previously published data demonstrate clearly that hyperglycemia worsens morbidity and mortality in patients in intensive care, those with acute myocardial infarction and stroke, and those undergoing coronary artery bypass grafts. The control of hyperglycemia with insulin infusion improves clinical outcomes in all classes of patients mentioned above. In this article we discuss data demonstrating an anti-inflammatory effect of insulin and a pro-inflammatory effect of glucose and free fatty acids and provide a mechanistic justification for the benefits of maintaining euglycemia with insulin infusions in the hospitalized patient. The regimes that infuse fixed doses of insulin with high rates of glucose are usually associated with hyperglycemia. This may neutralize the benefits of insulin. Such regimes should, therefore, be avoided in future and replaced by regimes that infuse insulin to restore and maintain euglycemia.