ABSTRACT
Most cases of insulin dependent diabetes mellitus (IDDM) are associated with autoimmune destruction of pancreatic cells producing insulin deficiency, but it may also follow pancreatitis or pancreatectomy. In non-insulin dependent diabetes mellitus (NIDDM) there is insulin resistance; insulin levels are initially high but later in the disease process they are reduced and overt hyperglycaemia develops. In the critical care setting, hyperglycaemia in IDDM should be managed by infusions of a short-acting insulin and frequent blood sugar measurement. The same is often true for NIDDM patients who can usually return to non-insulin control after resolution of their acute illness. Hyperglycaemia also occurs in normal individuals secondary to administration of glucose-containing solutions, corticosteroids, catecholamines, and the stress response. In this non-diabetic group, the hyperglycaemia resolves with the clinical illness and longterm anti-diabetes treatment is rarely required.
