Wei XY, Shen HN. Transient extreme insulin resistance in a critically ill patient: A case report. World J Clin Cases 2025; 13(8): 100889 [DOI: 10.12998/wjcc.v13.i8.100889]
Corresponding Author of This Article
Hsiu-Nien Shen, MD, PhD, Attending Doctor, Department of Intensive Care Medicine, Chi Mei Medical Center, No. 901 Zhonghua Road, Yongkang District, Tainan 710, Taiwan. hsiunian@gmail.com
Research Domain of This Article
Critical Care Medicine
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Mar 16, 2025; 13(8): 100889 Published online Mar 16, 2025. doi: 10.12998/wjcc.v13.i8.100889
Transient extreme insulin resistance in a critically ill patient: A case report
Xiu-Yu Wei, Hsiu-Nien Shen
Xiu-Yu Wei, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 407, Taiwan
Hsiu-Nien Shen, Department of Intensive Care Medicine, Chi Mei Medical Center, Tainan 710, Taiwan
Author contributions: Wei XY collected the data and wrote the manuscript; Shen HN revised the manuscript; all authors have read and approved the final manuscript.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report.
Conflict-of-interest statement: All authors declare no conflict of interest in publishing the manuscript.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hsiu-Nien Shen, MD, PhD, Attending Doctor, Department of Intensive Care Medicine, Chi Mei Medical Center, No. 901 Zhonghua Road, Yongkang District, Tainan 710, Taiwan. hsiunian@gmail.com
Received: August 29, 2024 Revised: October 29, 2024 Accepted: November 22, 2024 Published online: March 16, 2025 Processing time: 97 Days and 0.4 Hours
Abstract
BACKGROUND
Acute hyperglycemia due to insulin resistance is common in critically ill patients, typically managed with insulin infusion. However, the occurrence of transient extreme insulin resistance (EIR) requiring exceptional high-dose insulin is rare.
CASE SUMMARY
We present the case of a 68-year-old woman with pneumonia who suffered an out-of-hospital cardiac arrest, subsequently developing transient EIR following a new episode of sepsis. Remarkably, insulin resistance rapidly reversed when the insulin infusion rate peaked at 960 units/hour (a total of 18224 units on that day), and it was promptly titrated down to zero upon achieving the target glucose level.
CONCLUSION
Exceptional high-dose insulin infusion may be required in critically ill patients with stress-related EIR, which is typically transient. Clinicians should be aware of the phenomenon and cautious to avoid hypoglycemia and fluid overload during the steep titration of high-dose insulin infusion.
Core Tip: The occurrence of transient extreme insulin resistance requiring exceptional high-dose insulin is rare, which is typically transient. Clinicians should be aware of the phenomenon and cautious to avoid hypoglycemia and fluid overload during the steep titration of high-dose insulin infusion.
