Glucose homoeostasis following injury.

Metabolic changes following injury have been observed for many years, and John Hunter discussed such changes in 1794. Changes in carbohydrate metabolism have been observed for a similar length of time, and glycosuria and hyperglycaemia have been reported by a number of observers. This paper records and quantitates the extent of hyperglycaemia in patients undergoing surgery of different degrees of severity and relates them to changes in blood insulin, growth hormone, cortisol, and catecholamine concentrations. Further animal studies were performed which suggested that a fall in intracellular glucose utilisation may be a contributory factor. The use of isotope labelling of glucose in man has enabled further studies to be done to clarify changes in exchangeable glucose mass, replacement rate, and space both in the normal situation and in the presence of infusions of glucagon, noradrenaline, glucose, and amino-acids. The hyperglycaemia is clearly the result of a complex interaction of changes in the availability and activity of hormones which control glucose metabolism both within and outside the cell.