Stress-induced hyperglycemia is a relevant prognostic factor also in the presence of diabetes. Mild-to-moderate stress hyperglycemia is considered a protective reaction to providing fuel for the immune system and brain at a time of stress; however, the additional hyperglycemia and insulin resistance it creates may be potentially deleterious directly contributing to adverse outcomes via endothelial dysfunction, increased free radical production (oxidative stress), inflammatory responses, and vascular and immune dysfunction.

In recent studies, we found that immediate treatment of hyperglycemia by basal-bolus insulin injection, irrespective of the presence of diabetes, reduced adverse events, and septic complications in surgical patients.

To improve outcomes of critical elderly patients, adequate treatment of hyperglycemia may be systematic implemented also in ED, in keeping with the results observed in ICUs.

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