Mr. Simon is diagnosed with type 2 diabetes mellitus and admitted to the medical unit with pneumonia. His oral antidiabetic medication has been discontinued and now he is receiving insulin for glucose control. Which of the following statements best explains the rationale for this change in medication?
- Insulin administration will help prevent hypoglycemia during the illness.
- Infection has compromised beta cell function so the patient will need insulin from now on.
- Acute illnesses like pneumonia will cause increased insulin resistance.
- Stress-related states such as infections increase risk of hyperglycemia.
Answer:
4. Stress-related states such as infections increase risk of hyperglycemia.
Infection causes a stress response in the body by increasing hormones glucocorticoids and epinephrine, which suppress the natural immune response. These stress hormones work against insulin and cause an increase in blood glucose levels. With high glucose levels, white cells are slowed and take more time to fight the infection. Type 2 diabetics may temporarily require insulin during acute illnesses and hospitalizations, but they often return to their normal medication regimen after they recover. Insulin injections also permit more accurate control of glucose levels than oral medications.