A patient is admitted to the hospital with acute myocardial infarction and has a blood sugar of 180 mg/dL. The patient has never been diagnosed with diabetes
What is the best explanation for a high glucose in a patient without diabetes? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. The physiologic stress of a large meal plus a myocardial infarction causes hyperglycemia.
2. Insulin resistance is caused by pro-inflammatory factors.
3. Insulin resistance is caused by beta blockers and nitroglycerin, which are commonly used to treat myocardial infarction.
4. Myocardial infarction causes a physiologic stress response that causes the body to enter a hypermetabolic state.
5. Glucagon, cortisol, and epinephrine cause hyperglycemia.
2,4,5
Rationale 1: The blood glucose does not normally elevate to 180 mg/dL even after a large meal.
Rationale 2: During a critical illness, pro-inflammatory factors cause insulin resistance, which also leads to hyperglycemia.
Rationale 3: Beta blockers do mask the signs of hypoglycemia, but neither beta blockers nor nitroglycerin cause hyperglycemia.
Rationale 4: A critical illness such as a myocardial infarction causes a physiologic stress response that causes the body to enter a hypermetabolic state in an attempt to heal.
Rationale 5: In a critical illness the reaction to counterregulatory hormones such as epinephrine, cortisol, and glucagon has a direct hormonal effect to produce hyperglycemia.
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