Transient extreme insulin resistance in a critically ill patient: A case report.

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.