Insulin, More than a Metabolic Hormone; Focuse in Sepsis Beyond Glucose Control

Abstract

Sepsis is the result of an inadequate and harmful host response caused by an infection. Within this, multiple pathways are activated to resolve the infection, however the inappropriate activation of these comes to compromise different systems that explain the complexity of sepsis. Insulin has been studied extensively in terms of the control of hyperglycemia in sepsis, but the benefits of insulin can not only be attributed to glucose control per se, in this review we present some of the other functions that insulin fulfills in the sepsis beyond the control of glycemia. Materials and Methods: We reviewed Pubmed, Ovid, Embase, Lilacs and published textbook chapters, all articles related to physiopathology and effects of insulin in sepsis. Articles carried out in humans and animals were included, without limit of publication date. Conclusion: Insulin has different functions in sepsis beyond the control of glucose, in which the control or regulation of the inflammatory response is the fundamental axis, since it is involved in all the mechanisms that relate sepsis to insulin. It can not be determined what percentage or proportion of the insulin benefit is due to the control of glucose or the regulatory mechanism on inflammation, microcirculation, expression of free radicals, etc. The understanding of insulin in the different pathophysiological pathways of sepsis should be further deepened since the decomposition of the functions of this hormone as well as of other alternate routes, is what will allow the optimization of all the therapeutic arsenals that exist to improve the morbidity and mortality of these patients.